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Nurse Practitioner Hopes to Return to Rural Hometown

Posted By Administration, Friday, October 13, 2017

 

It’s common story in small towns across Oklahoma and the United States: kids leave for college and few return to build a life in the community where they grew up. Instead, they seek out better job prospects in larger cities. Even those who might want to return home don’t due to a lack of job prospects.

Stephanie Keesee doesn’t want that to be her story. After becoming a nurse practitioner, she knew she wanted to return home to care for her family, friends and neighbors. To do that, she’s planning to open her own clinic in her hometown of Holdenville.

“I was born and raised in Holdenville. This is where we live, on a ranch. We’re not moving,” Keesee said. “I want to serve the community I grew up in.”

Keesee earned her B.A. in nursing from the University of Oklahoma College of Nursing in 2005. She worked as an RN for a decade before earning her Masters of Nursing from OU and becoming a family nurse practitioner.

For the past year, she’s been living in Holdenville and commuting to work at Wellspring Family Clinic in Broken Arrow, while dreaming of opening a clinic closer to home in rural Oklahoma.

“Rural Oklahoma faces such a shortage of health care,” she said. “I don’t think people understand until you can’t get in to see a provider, whether an NP or physician. My brother’s girlfriend had to see a doctor last week and it took her two weeks to get in. A minor issue can become a serious issue if you’re waiting two weeks to get an appointment.”

Keesee moved one step closer to her dream earlier this year when she purchased a building for a clinic, which she plans to open next summer. The time is right, she said, because the two nearby providers will retire in the next couple of years.

But she still faces one major obstacle — finding an authorizing physician. In order to practice and prescribe medications, she must sign a collaborative agreement with a physician. Because she’s on leave and not currently working, she terminated her agreement with her previous collaborating physician.

“I was paying $500 a month out-of-pocket for that signature,” she said. “In almost two years, I’ve seen him once. It didn’t make sense to keep paying when I wasn’t working.”

So far, her search for a new collaborative physician isn’t going well, but she noted that the legislature could take action to do away with that outdated regulation and allow full practice authority for nurse practitioners before her clinic opens.

“I’ve contacted five physicians so far, and all of those have been dead ends,” she said. “But if the legislature takes action next session, then I won’t have to worry about it. I won’t have to worry about the payments, and I won’t have to worry about what happens if my physician retires or moves or dies unexpectedly. I could just take care of serving the people in this community.

“There’s an elderly population and a lot of young kids here,” she said. “They’re a majority SoonerCare population and it’s hard to find care. “

She stressed that one barrier to health care in rural Oklahoma wasn’t just a lack of providers. That issue is exacerbated by a lack of providers who accept SoonerCare, the state’s Medicaid program.

She cited her experience at the Wellspring Clinic.

“Once a week we’d have new SoonerCare patients come in. They were people who’d lost jobs or insurance and now they were on SoonerCare,” she said. “They’d be COPD (Chronic Obstructive Pulmonary Disease) patients who need inhalers to live. Their previous provider wouldn’t provide inhalers with SoonerCare, so now their condition was that much worse and they were desperate. It was all because they lost their job. We were one of the few clinics in the area that would take SoonerCare.”

Keesee is hopeful that, by this time next year, her clinic will be open and serving those patients who have to drive 30 minutes or more for care today.

“These are my friends and family and I want to care for them,” she said. “It’s one of the main reasons I became a nurse in the first place.”

 

 

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Nurse Practitioner Finds New Way to Serve the Community

Posted By Administration, Friday, September 15, 2017

For Kerri Ellis, a nurse practitioner in Beggs, Oklahoma, caring for patients goes beyond treating a case of the flu or managing diabetes. For Ellis, serving patients means looking at all the challenges they face and building a strong and supportive community.

That’s why she started a library.

It’s not a full-size, brick-and-mortar library, but a Little Free Library. The library is a weatherproof box outside her clinic that can hold around 100 books. Anyone in the community is free to pick up or leave a book anytime. This library is open 24/7.

“This is a medically underserved, primarily indigent community with no recreational things for children to do, and certainly no library,” Ellis said.

She has been caring for residents in rural Okmulgee County since she bought the CliniCo rural health clinic in 2001. In that time, her clinic has provided health services to more than 8,000 patients of all ages

“I saw a story about Little Free Library, which started in Wisconsin and the idea just caught fire with me,” she said.

Ellis said there are currently 50,000 Little Free Libraries across the world – in every state and in 70 countries – so it fills a gap in Beggs since the nearest library is in Okmulgee, 23 miles away.

Starting the library is closely tied to caring for the health of her patients, she said, citing a 2014 policy statement form the American Academy of Pediatrics that recommends parent-child home reading starting at birth and continuing at least through kindergarten to encourage brain development and socioeconomic wellbeing.

“Kids who have access to books are more prepared to start school. It literally changes the brain,” Ellis said. “Social mobility is improved just by something as simple as having a book, and 60 percent of low-income households don’t have a book available.

“As a nurse practitioner, you’re so often trying to fix a problem, trying to fix something that is already broken,” she said.  “This a chance to fix something before it’s a problem. The data is clear – having books improves kids’ development and their lives for years to come.

The grand opening isn’t until Sept. 23, but the local community has already responded to the Little Free Library with enthusiasm, donating more than 1,800 books in four weeks. The books offer something for every age and every interest. Because of limited space in the weatherproof box, she has shelves of books inside her clinic and tries to switch books out every day.

The program has been such a success that Ellis and her staff are able to give a free age-appropriate book to every child they see for a regular well-child visit. She has also applied to partner with another nonprofit, Reach Out and Read, which could generate more resources and support.

“What we do as nurse practitioners – a lot of people don’t understand it, and it’s difficult to explain. We take a more holistic approach and try to make sure we’re looking at the needs of the whole person,” she said. “We don’t just say ‘take this medicine.’ We try to make sure they have the resources to get the medicine and know where to go to get it and how to use it properly.

“By providing these books, we can do so much good. There’s so much science behind the benefits of reading. It’s something the whole community can see and benefit from, and it makes a huge difference,” she said.

The community of Beggs, for its part, has embraced the new Little Free Library wholeheartedly.

“We started a Facebook page for the library, and parents are posting what they call ‘shelfies,’ pictures of parents and kids together with their books,” Ellis said. “It’s just wonderful to watch the kids ride up on their bikes every day to look through the books and pick one to take home.”

The Grand Opening celebration is planned for 2 to 4 p.m. Saturday, Sept. 23 at CliniCo, 103 E Main St. in Beggs. Several local and state dignitaries are expected to attend the celebration, including state Sen. Roger Thompson, state Rep. Steve Kouplen and AONP Executive Director Benny Vanatta.

If you’d like to contribute, Kerri said she could use scholastic books or any bookstore gift cards to obtain new books for the pediatric-focused Reach Out and Read program. The CliniCo Rural Health Clinic mailing address is PO Box 478, Beggs, OK 74421.

She also encouraged other nurse practitioners to investigate the program for themselves.

“I would really love to see more NP-owned and run clinics start these programs all over our state, especially in rural areas,” she said. “It improves lives, including those of the library stewards!”  

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Nurse Practitioners More Likely to Serve Rural Areas

Posted By Administration, Wednesday, September 6, 2017

Receiving primary health care services can be an ordeal for some Oklahomans, particularly those living in rural areas of the state. As medical providers increasingly consolidate, rural residents find themselves driving farther for even basic health services.

A study from Montana State University indicates that allowing nurse practitioners to work to the full extent of their education and training could be a part of the solution.

The study, published in the January 2016 issue of Medical Care, the Journal of the American Public Health Association found that nurse practitioners are more likely than physicians to practice in rural areas.

Even more interesting, it found that rural residents’ access to health care differed from state to state depending on, among other things, a state’s scope-of-practice laws. 

“For the 17 states that did not restrict scope-of-practice laws governing nurse practitioners at the time of the study, 62 percent of the state’s population had high geographic accessibility to a primary care nurse practitioner,” said Peter Buerhaus, the study’s author. “In contrast, in the 21 states that fully restricted the practice of nurse practitioners, the percent of the population with high accessibility to a primary care clinician decreased considerably.”

Oklahoma ranks 49th in physician-to-patient ratio, so the demand for health care already exceeds the supply, and this problem becomes more apparent in rural areas of our state.

Nurse practitioners have a master’s degree or doctorate and are trained to provide many health care services, but outdated state laws create barriers to them starting new clinics. Oklahoma’s nurse practitioners are an under-utilized resource, and they could be doing more to care for Oklahomans. It’s time that Oklahomans enjoyed that same access to quality health care that can be found in 22 other states.

“The point is that we can do better in terms of patient accessibility to primary care,” Buerhaus said. “This is not a nurse practitioner versus physician issue. It’s an issue that is driven by the question of how do we best expand access to health care using all available resources?”

To read more about the Montana State University study, click here.

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Featured NP: Sara Buster

Posted By Administration, Wednesday, August 2, 2017

 

In May, Sara Buster earned her Doctorate of Nursing Practice - Family Nurse Practitioner Degree from Oklahoma City University’s Kramer School of Nursing. She also received the Heart of Nursing Award, which recognizes a student in each class who demonstrates caring and compassion, patient advocacy and enthusiasm.

Sara grew up in Watson in rural McCurtain County, and graduated from nearby Smithville High School. AONP caught up to Sara to learn what drew her to nursing and to learn about the future of the profession.

 

Why did you decide to go into nursing?

I’ve always wanted to be a RN since the time I was very young. I have always enjoyed helping people. I also love how nursing mixes helping people with science.

 

Why did you decide to go beyond being an RN to become a nurse practitioner?

When I was growing up, I was sick a lot so I was constantly at the “doctor’s office.” It was always a nurse practitioner and the nurses that took care of my family and me. When I became a RN, I became interested in what caused illnesses and how to stop them or slow the progression. I feel that nurse practitioners play an important role in primary care, health promotion, and disease prevention.

 

Are there any nurses or teachers along the way who you consider to be role models?

All of the teachers I had at Kramer School of Nursing were fantastic, and I consider them all to be role models. Dr. Crawford who is the director of the DNP program was a great role model for me and helped me a lot both academically and as a mentor.

 

What do you find most rewarding about the work?

I love how nurse practitioners can develop lifelong relationships with their patients and patients’ families. It is truly rewarding to care for patients of all ages throughout their lives.

 

Now that you’ve graduated, what are your career goals? What kind of setting would you like to work in?

My career goals involve working in a primary care clinic in a rural setting. I think nurse practitioners play an important role in serving this underserved population.

 

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States with Full Practice Authority Among the Healthiest

Posted By Administration, Thursday, June 15, 2017

During the most recent legislative session, some opponents of full practice authority for nurse practitioners argued the move would put patient health and safety at risk. The fact is, full practice authority simply means that NPs would be allowed to put their full education and training to work caring for Oklahomans.

The opponents offered no data to back up their claim and, in fact, national data shows a very different picture. Compare the states with full practice authority against national state health rankings.

Here’s the regulatory map from the American Association of Nurse Practitioners:

Here are the 2016 state health rankings compiled by the United Health Foundation. Using the same colors as above, we color-coded the states to indicate each regulatory environment. There is a lot of green in the top of the rankings.

Eighteen of the top 25 states give NPs full practice authority. Only three of the top 25 states were as restrictive as Oklahoma, which ranked 46th. Of the 22 states with full practice authority, New Mexico had the lowest ranking at 38th.

While that doesn’t prove that full practice authority results in better health for citizens — there are dozens of variables that figure into a population’s health — it refutes the idea that nurse practitioners offer a lesser quality of care.

Study after study has debunked the idea that patients suffer when an NP is the primary care provider. The National Governors Association looked at those studies and wrote, “None of the studies in NGA’s literature review raise concerns about the quality of care offered by NPs. Most studies showed that NP-provided care is comparable to physician-provided care on several process and outcome measures. Moreover, the stud­ies suggest that NPs may provide improved access to care.”

Within their scope of practice, nurse practitioners offer health care outcomes that are comparable to doctors. They also offer our state a chance to improve access to quality health care for all Oklahomans. Many lawmakers got that message this year and supported lifting these antiquated restrictions. But that support wasn’t universal. Supporters of NP full practice authority need to keep working to build support in the legislature and awareness in the general public.

Our state, and the health of Oklahomans, has nowhere to go but up.

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Thank You Legislators!

Posted By Administration, Friday, May 19, 2017

AONP thanks the 72 members of the Oklahoma House of Representatives who supported House Bill 1013. We are especially thankful for the bill’s authors, Rep. Josh Cockroft and Sen. AJ Griffin. Gaining full practice authority is not an easy task, but the vote to pass the bill out of the House considerably increased public awareness and support of the need for full practice authority in Oklahoma.

We would also like to thank the many senators who were supportive of the measure. Although Sen. Yen did not grant the bill a hearing, the support we received from the Senate is greatly appreciated. The legislators in the House and the Senate who supported our measure understand the difficulties many Oklahomans have in accessing quality, affordable health care, and they made it clear that they stand on the side of improving the lives and the health of Oklahomans.

If your representative voted for the bill and you have not yet reached out to them, call or email to thank them for their vote and support of full practice authority. To identify your legislators and find their contact information, search on the Oklahoma State Legislature website. You can find the voting record for HB 1013 online as well. Calling or emailing builds goodwill and lays the groundwork for next legislative session. Plus, it’s just a nice thing to do.

Gaining full practice authority will drastically change and improve the lives of Oklahomans. By allowing nurse practitioners to practice at the full extent of their training and education, access to rural health care will increase and the shortage of primary care providers in the state will be addressed. The progress made throughout the last year and, most recently, during the legislative session created a strong foundation to build upon in the coming months.

Continue working throughout the rest of this year, speaking with your legislators and in your communities about the need for full practice authority. The resources on our legislative page will continue to be great tools as we continue to work together toward full practice authority.

 

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AONP Raises Awareness of Full Practice Authority

Posted By Administration, Friday, April 28, 2017

As this year’s legislative session nears its end, AONP leadership would like to take this opportunity to extend thanks to all who helped support our bill for full practice authority, House Bill 1013.

Whether you made calls or sent emails to legislators, spoke on behalf of full practice authority to your neighbors, or joined us at the Capitol for our Legislative Day, all of your efforts were greatly appreciated and certainly made a difference.

It’s true that this legislative session did not turn out the way we had hoped as HB 1013 failed to get a hearing in the Senate, but we consider our progress this year a great success. The bill passed the Oklahoma House of Representatives by a 72-20, bipartisan vote and we are encouraged by the victory. The success shows how popular the measure was among lawmakers and their constituents. This legislative session dramatically raised the public’s awareness of full practice authority. Along with awareness, public support of full practice authority increased greatly. Although the measure did not become law, huge progress was made.

This session, AONP worked to garner more than 100 news stories and opinion pieces in papers across the state, including several stories and supportive op-eds in the state’s largest paper, The Oklahoman. We also had numerous television stories in both the Oklahoma City and Tulsa markets. Here’s a small sample of stories that ran across the state.

The Oklahoman op-ed published January 19

Tahlequah Daily Press article published February 14

Grand Lake News op-ed published January 30

The Oklahoman article published March 2

The Lawton Constitution article published February 2

KOCO story from February 8

The Oklahoman op-ed published February 10

The Journal Record article published March 17

Hospital administrators, AARP Oklahoma, the Oklahoma chapter of Americans for Prosperity, and even some physicians showed their support. A tele-town hall hosted by AARP Oklahoma drew more than 6,000 attendees who were able to learn more about the issue.

As we have seen in other states, gaining full practice authority can be a multi-year process. Momentum for full practice authority continues to grow as more people learn about the issue, and the work accomplished this year will pay dividends down the road.

Over the next few months, nurse practitioners can help further the cause by talking to friends, neighbors and local civic groups about the issue, building additional support and correcting any misinformation. We look forward to continuing our efforts to gain full practice authority in Oklahoma.

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The Oklahoman Encourages Yen to Hear Measure Increasing Health Care Access

Posted By Administration, Wednesday, April 5, 2017

On Saturday, the state’s largest newspaper encouraged Sen. Ervin Yen to hear HB 1013, which would improve access to health care for all Oklahomans by removing needless financial barriers and outdated regulations that limit nurse practitioners in our state. Editorial writers at The Oklahoman cited the measure’s broad support in the House of Representatives and its merit in tackling a real problem that affects many Oklahomans.

The Oklahoman wrote:

The Oklahoma Association of Nurse Practitioners is worried about the future of a bill that would help its members. House Bill 1013 seeks to give full practice authority to nurse practitioners and advance practice registered nurses. Presently, those nurses must have a collaborative agreement with a physician to provide health services. The agreements are costly, but nursing officials say they provide little real benefit to patients. The House voted 72-20 in favor of HB 1013, but the practitioners' group says it may not be given a hearing in the Senate Health and Human Services Committee. Our hope is that even if he opposes the bill, committee chairman Sen. Ervin Yen, R-Oklahoma City, will allow it to be heard prior to the April 13 deadline. This is a substantive issue that merits consideration by his committee and potentially by the full Senate.

Currently, nurse practitioners have full practice authority in 22 states, the District of Columbia and in veterans and military facilities across the country.

To read the editorial on The Oklahoman’s website, click here and scroll down.

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Oklahomans Want Greater Access to Health Care

Posted By Administration, Wednesday, March 29, 2017
Last week, more than 6,000 Oklahomans took part in a tele-town hall sponsored by AARP Oklahoma to learn more about House Bill 1013 and full practice authority for nurse practitioners.

That level of engagement shouldn’t be surprising. A poll conducted by SoonerPoll found that 86.7 percent of respondents support allowing nurse practitioners to put their full education and training to work in caring for Oklahomans.

The popular support for nurse practitioners is also reflected in the Oklahoma House of Representatives’ 72-20 vote in favor of HB 1013. Legislators from across the state and the political spectrum — Republicans and Democrats, urban, rural and suburban lawmakers — voted to give Oklahomans increased access to health care.

HB 1013 also has support from professionals throughout the health care industry, including hospital administrators and doctors.

Simply put, the more people learn about nurse practitioners and the barriers they face when caring for Oklahomans, the more they favor HB 1013. 

Earlier this year, South Dakota became the 22nd state to grant full practice authority to nurse practitioners.  The U.S. Department of Veterans Affairs gave full practice authority to NPs working in its facilities late last year.

It’s time to do away with antiquated regulations that require nurse practitioners to sign superficial “collaborative” agreements with a doctor. Those agreements can cost NPs thousands of dollars a month, offer no benefits to patients and unnecessarily restrict consumer choice and access to care.

Unfortunately, despite popular support, HB 1013 may not even receive a committee hearing in the state Senate. That is why it’s more important now than ever for Oklahomans who support modernizing our health care laws to contact their state senators.

Contact your state senators, tell them you support HB 1013 and ask that the bill receive a committee hearing. If you don’t know who represents you in the Oklahoma State Senate, click here.

HB 1013 is a simple and common-sense step toward improving health care access for all Oklahomans. Call your state senator today and make a difference in the lives of your friends and neighbors who lack access to affordable, quality health care.

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HB 1013 Gains Momentum

Posted By Administration, Friday, March 10, 2017
Momentum is building behind HB 1013, which would let nurse practitioners put their full education and training to use caring for Oklahomans. The measure passed the Oklahoma House of Representatives last week and is waiting on a hearing in a Senate committee.

That momentum isn’t surprising. A large majority of Oklahomans supports the idea, according to a poll conducted by AARP Oklahoma.

The poll, released in January 2016, asked 410 likely voters, “Do you support or oppose allowing nurse practitioners, who have advanced training, to serve as the primary or acute care provider of record for a patient?” In response, 86.7% said they support allowing a nurse practitioner to operate with full practice authority.

The truth is, Oklahomans want better access to quality, affordable health care. Too many Oklahomans drive long distances and wait days for appointments. It’s not just about the inconvenience of long drives; it’s a problem that harms the health of our residents.

Some opponents of HB 1013 have argued it would create a “two-tier” health care system. Nothing could be further from the truth.

A number of studies have looked at the health outcomes of patients who see physicians vs. those who see nurse practitioners. Those studies overwhelmingly concluded that nurse practitioners have patient outcomes equivalent to those of doctors.

The National Governors Association reviewed the evidence and wrote, “None of the studies in NGA’s literature review raise concerns about the quality of care offered by NPs. Most studies showed that NP-provided care is comparable to physician-provided care on several process and outcome measures. Moreover, the studies suggest that NPs may provide improved access to care.”

The truth is that Oklahoma already has a two-tier health care system. HB 1013 is a step toward addressing that. Sixty-four of Oklahoma’s 77 counties are designated as primary care shortage areas and our state ranks 49th in physician-to-patient ratio. Our state ranks 46th in health overall. Oklahoma needs more health care providers.

HB 1013 is hardly a radical idea. Just last month South Dakota became the 22nd state to authorize nurse practitioners to work to the full extent of their education and training. HB 1013 is a simple, common-sense step forward in addressing the provider shortage. 

Oklahomans deserve the same consumer choice and access to care that residents of nearly half the states already enjoy. If you agree, please contact your state Senator and ask them to support HB 1013.
 

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