Past AONP president Toni Pratt-Reid spoke to new lawmakers during an orientation—Legislative Boot Camp—hosted by the State Chamber on Dec. 6. We need you to contact legislators, too!

We must take advantage of this time to get our message to the new lawmakers and reiterate that message for returning legislators. Nurse practitioners can do more to increase access to health care in every part of our state, but the outdated requirement for a collaborative agreement is holding us back. Red tape and the financial interests of a few physicians are key components limiting increased health care access for Oklahomans.

Contact your state legislators now, before we get into the full swing of the holidays! Tell them about your education, training and what you do every day to care for patients. Share with lawmakers the ways you, as a nurse practitioner, could serve more of your community’s citizens all while increasing consumer choice and providing more health care options to underserved parts of our state.

If you’re unsure of how to get started, we have some talking points and other resources on the legislative page of the AONP website. While you’re on our website, take a moment to sign up for text alerts through Voter Voice. That way, we can contact you quickly with action alerts during the legislative session.

If you’re unsure who represents you in the legislature, you can find that information here. Once you’ve talked to your state House and Senate members, let us know how it went. Email us at Benny@npofoklahoma.com.

In recent years, we’ve been building support in the legislature and working to elect the candidates who support us. The 2019 session is full of promise and the time is right for legislative victory.

Cynthia Roe, a nurse practitioner from Lindsay, OK, won her race for House District 42. Because of her support for full practice authority, the Oklahoma State Medical Association spent nearly $8,000 against her in the closing days of the race. The anesthesiologists’ political action committee donated $2,000 to her opponent in the course of the campaign.

AONP volunteers knocked doors for Cynthia in Pauls Valley the Saturday prior to Election Day.  Voters saw through the misinformation that was being spread, and she won her race handedly.

Across Oklahoma, candidates who are favorable to full practice authority won. They won in metro districts and in small towns. They are Republicans and they are Democrats.

NPs spent a lot of time this fall talking to candidates and making the case for full practice authority. We’ve worked hard, and now the makeup of the new legislature gives us an excellent opportunity heading into 2019.

That’s no reason to be complacent, though. With the elections behind us, the work of AONP and nurse practitioners across the state turns to the legislative session that starts in February.

Talk to your legislators about nurse practitioners and full practice authority. Brand new legislators may not be familiar with the issue, so it’s our job to educate them. We’ve got a toolkit on our website to help you get started.

Once you talk to them, let us know how it went. Email benny@npofoklahoma.com and we’ll keep a tally of who supports us and who needs more information. 2019 can be our year, but we’ve got a lot of work to do to get our legislation passed into law.

 Through the AONP PAC, we pool our resources and support candidates who support our drive to increase health care access in Oklahoma. This is critical. We need your contribution more than ever. Opponents of full practice authority are spending money to elect candidates who side with them. We need to make our voices heard as well.

 This year, we distributed a survey to legislative candidates to educate them and get their opinions on the issues that are important to nurse practitioners. What we’ve seen is strong support for our position. A list of candidates who replied to our survey and expressed favorable support for full practice authority can be found below.

 While candidate research is important, we also need to back up research with action. To do that, we need your help!

 Our work won’t stop with the election. At the annual conference, we also unveiled Voter Voice, a powerful tool to harness advocacy by nurse practitioners from across the state. If you choose to receive notifications, we can alert you via text or push notification when to call your legislators at the State Capitol. This will be a critical tool when the legislative session starts in February.

 You can register for an account HERE. You also can sign up for text updates, simply text AONP to 50457. And don’t forget to download the Voter Voice app for iPhone or Android and opt into notifications from AONP!

 There are great things ahead for AONP and for nurse practitioners across the state. We’ve spent years educating the public about full practice authority and building support in the legislature. With everyone working together, we’ll get this initiative through the legislature and signed into law!

See the attached list of legislators who replied to our survey with favorable support for full practice authority.

 AONP has already started this process by sending a survey to all registered candidates who made it through the primary and runoff elections. As the results of that survey come in, we’ll be deciding on candidate support.

 But we need your help on the ground, too.

 Several opponents of full practice authority were defeated during the runoff and primary elections. This results in many new faces in the legislature when the 2019 session starts in February. Those new members may not be familiar with the health care challenges facing our state or how nurse practitioners can help increase access to affordable, quality care.

 It’s up to us to explain it to them. AONP has the tools to help you!

 If you’re unsure of what to say or how to explain the issue, the Legislative page on our website has a toolkit that includes full practice authority talking points. If you don’t know who’s running for the legislature in your area, visit the Oklahoma State Election Board site or call your county election board.

 Once you’ve identified your local candidates, get out and find her or him and start the conversation about full practice authority. Throughout the fall, candidates will be attending fairs, parades, festivals and other events in their prospective districts. Most candidates have a website or a Facebook page with contact information.

 Once you've spoken to your candidates, tell us how it went! AONP leadership needs to know who supports us, who doesn't and who needs more information about the issue. Call us at 405-445-4874 or email Benny@npofoklahoma.com and tell us about your conversations.

 And, don’t forget how important it is to support the candidates who support us. Contributions to the AONP PAC help us elect legislators who believe in increasing health care access for Oklahomans.

 We’ve been building momentum for full practice authority in recent years and we’re closer than ever to success. This fall we have the opportunity to elect legislators who will get us across the finish line.

But there’s more that we can do. It’s not enough to just know where candidates stand—we need to support those candidates who will support us. That’s why the AONP political action committee (PAC) is so important. It’s a tool we can use to help elect legislators who share our views on these issues.

While any of us can (and should!) give small donations to candidates we support, the PAC allows us to band together to make a bigger impact in races across the state. As our members talk to candidates throughout the state and report on their findings, we’re looking for those candidates who are worthy of support this fall. 

AONP leadership is also speaking to a number of legislators and candidates and determining where our money and our manpower will be most effective in building a strong legislative coalition.

We need your help in this effort! It’s easy to give to the AONP PAC. You can set up small, reoccurring donations that will have a big impact over time. Pooling our resources offers the best chance to have an impact in close legislative races.

We’ll also be bringing our members out to knock doors and campaign for some candidates who support us. Be on the lookout. We’ll let you know about upcoming campaign opportunities via email and on our Facebook page.

Until then, keep talking to candidates in your community about full practice authority. We’ve made great strides over the last few years. This November we can ride our current momentum to legislative victory! 

The Oklahoma primaries were held on June 26 and a number of candidates are facing run-off elections on August 28. Now is the time to educate legislative candidates about the role of nurse practitioners in the health care industry and get their thoughts on the issue.

State House and Senate candidates are out knocking doors, attending community events and hosting rallies and fundraisers in their districts. Candidates want to connect with people in their districts. They’re accessible and open to conversations.

If you’re not sure who is running in your area, contact your county election board. They can also confirm if you’re registered to vote.

Once you know the names of your local candidates, seek out opportunities to speak to them. Most campaigns will have a website, or at least a Facebook page, with contact information. It might also list upcoming campaign events.

Candidates will also be found around the community at events like parades, fairs and festivals. Introduce yourself and start a conversation. If you need tips on talking to candidates or talking about full practice authority, check out the toolkit on our legislative page.

Once you're spoken to your candidates, let us know how it went! AONP leadership needs to know who supports us, who doesn't and who needs more information about the issue. Call us at 405-445-4874 or email Benny@npofoklahoma.com and tell us about your conversations.

We’ve made incredible strides in the last few years. More than ever, the public and lawmakers understand the issue and they support our drive for full practice authority. Oklahomans want the freedom to choose their health care providers, and they want care that is accessible and affordable. Let’s work together to elect candidates that will make that a reality.

A healthy business climate in Oklahoma depends on many factors — our cost of living, regulatory environment, corporate tax rates and more. In many of these areas, Oklahoma’s business environment is strong. One area where our state needs a check-up, however, is the health of our citizens and workforce.

The overall health of Oklahoma residents is poor compared to other states, and many in our state lack easy access to a primary care provider.

Oklahoma ranks 49th in physician-to-patient ratio, and significant portions of 76 of our 77 counties are designated primary care shortage areas. We desperately need more primary care providers, and this problem affects both the health of Oklahomans and economic development efforts in our state.

Businesses are unlikely to relocate, grow or expand in areas without adequate access to health care for their employees. Granting full practice authority to nurse practitioners could change that.

Every day in Oklahoma, thousands of people already rely on nurse practitioners for their primary care. For some, seeing a NP is a personal preference; for others, NPs are the only viable option, given the scarcity of primary care providers in many rural areas. 

Under Oklahoma’s current regulations, nurse practitioners must have a signed “collaborative agreement” with a physician, even though little or no collaboration may take place. Often, these agreements are merely signatures on a piece of paper, signatures that can cost a nurse practitioner thousands of dollars each month. 

Decades ago, when advance practice registered nurses were a new concept, this sort of regulation may have made sense. However, nurse practitioners have proven their effectiveness and professionalism over the years. 

Today, this regulation is unnecessary red tape that creates a financial barrier to opening new clinics. Without additional providers and greater access to health care services, Oklahoma will maintain its poor health outcomes and perpetuate the status quo. Oklahomans need health care that is both affordable and close to home.

There are nurse practitioners across the state ready to do their part caring for Oklahomans who live and work in designated primary care shortage areas/underserved communities. Plus, creating a more favorable regulatory environment could draw nurse practitioners from neighboring Texas, where they face similar restrictions.

This idea is cropping up across the country, with 22 states and the District of Columbia having already modernized their laws and regulations to provide greater health care access. Oklahomans deserve the same access.

Full practice authority for nurse practitioners will support economic development efforts across our state and provide Oklahoma businesses a healthier and more prosperous workforce. We look forward to supporting the legislature as they tackle this important health care issue.

That’s the takeaway from a survey conducted by AARP Oklahoma last fall. The poll found that 87 percent of Oklahoma voters age 40 and older support allowing nurse practitioners to serve as the primary or acute care provider of record for a patient.

That support cuts across political divides, with 84 percent of Republicans, 92 percent of Democrats and 89 percent of independents supporting the idea.

It’s no surprise, then, that a bill allowing nurse practitioners to put their full education and training to work caring for Oklahomans sailed through the Oklahoma House of Representatives last year on a bipartisan 72-20 vote.

That measure, House Bill 1013 by Rep. Josh Cockroft and Sen. AJ Griffin, has since been bottled up in the Senate Health and Human Services Committee. The committee’s chairman, Sen. Ervin Yen, refuses to hear the bill.

Oklahoma is in desperate need of more primary care providers. The state is 49^th in physician-to-patient ratio, and all or part of 76 out of 77 counties are designated as primary care shortage areas

Nurse practitioners can do more to care for Oklahomans. They know the level of care they are educated to provide, and they are already regulated by the Oklahoma Board of Nursing. Patient safety hasn’t been an issue in the 22 other states where NPs enjoy full practice authority.

It’s time to cut through the red tape and let NPs do their jobs. If you agree, contact your State Senator today and ask them to co-author HB 1013! 

Approximately 80 nurse practitioners attended AONP’s legislative day in support of House Bill 1013 by Rep. Josh Cockroft and Sen. AJ Griffin. We heard from a number of speakers, including AARP Oklahoma executive director Sean Voskuhl, before visiting with lawmakers about ideas to increase access to health care in the Sooner State.

HB 1013, which was introduced last year, aims to do away with the outdated requirement that NPs sign a collaborative agreement with a physician.

This is a common-sense solution to a real problem.

The truth is, our state is woefully short of primary care providers and that impacts the health of Oklahomans in substantial and measurable ways. We’re 49^th in physician-to-patient ratio, and always in the bottom 10 in national health rankings. It’s time Oklahoma joined almost half the states in the country in giving NPs full practice authority.

HB 1013 passed the Oklahoma House of Representatives on a 72-20 vote last legislative session but failed to receive a hearing in the Senate Health and Human Services Committee. The measure is still active and we are urging legislators to pass it this year.

Nurse practitioners have been leading the charge to cut through Oklahoma’s needless red tape, and implement a reform that’s already working in almost half of all states. This issue has momentum now, with a number of advocacy and business groups joining in the fight.

House Bill 1013 must pass out of the Senate Health and Human Services Committee before April 12. If you’re tired of long drives or of waiting days for a primary care appointment, contact your state senator today and ask them to support and co-author HB 1013.

For more than a year now, AONP has been working for the passage of House Bill 1013, by Rep. Josh Cockroft and Sen. AJ Griffin. The bill would free the profession from costly and needless collaborative agreements. That legislation remains stalled in the Senate Health and Human Services committee.

 Now is the time to act to secure full practice authority!

 The day will begin at 9 a.m. across the street from the Capitol at the Oklahoma History Center, 800 Nazih Zuhdi Drive. Attendees will hear from several speakers, then take a bus to the Capitol to visit with legislators. The event concludes back at the History Center with lunch.

We need to turn out in large numbers to make a final push to get HB 1013 across the finish line. Today, 76 of Oklahoma’s 77 counties are designated as primary care shortage areas. Nurse practitioners can do more to care for their neighbors. We just need the legislature to remove the unnecessary red tape and let us put our education and training to use.

Join us on February 27 to make that goal a reality!

As the legislative session gets underway, we’ll hear a number of arguments against full practice authority for nurse practitioners. Many of these arguments relate to patient safety, though those concerns are unfounded. Study after study has shown that utilizing a nurse practitioner as a primary care provider does not put patients at risk, and may increase health care access for many.

Here are some of the arguments you’ll hear in the coming months, as well as responses you can use to educate the public and allay any concerns they may have.

NPs simply want to play doctor, but without putting in the time that physicians do for education and training.

Nurse practitioners have at least a masters’ degree, and many have doctorates. In addition to their formal education, many NPs spend years working in clinical settings as registered nurses before achieving their NP certification. What’s more, they are not trying to “play doctor” or do anything more than NPs are trained to do.

Due to their lack of education and training, NPs are not qualified to make the best decisions for patients.

NPs know and understand their scope of practice. They know the limitations of their training and when to refer or consult with other professionals. Just like an ear, nose and throat specialist wouldn’t attempt heart surgery, NPs know what they are qualified to treat and what is outside their area of expertise. Many NPs currently run independent practices and they provide quality care for patients.

NPs practicing without physician oversight will create a patient-safety issue in Oklahoma.

Twenty-two states and the District of Columbia grant full practice authority to NPs. That’s almost half the country, yet we don’t hear about patient safety crises in those states. Several years ago, the National Governors Association undertook a review of the available research and concluded that:

“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.”

Further, a majority of states that employ full practice authority rank in the top half of the nation’s health rankings.

The best role for NPs is part of a team-based approach with a physician at the head of the team.

Nothing about full practice authority precludes nurse practitioners from working in a team-based setting. NPs are a vital part of many health care teams. Full practice authority simply means that nurse practitioners can practice as such without the necessary expense of paying for a collaborative agreement.

There’s no proof that NPs will open clinics in rural Oklahoma, and statistics show that NPs currently tend to practice where physicians are practicing.

NPs are currently clustered near physicians because they are required to have a collaborative agreement, and they face financial obstacles to opening their own clinics. In other words, they are practicing where they can currently find jobs.

Studies that have looked more in depth, though, have found that NPs are more likely than physicians to locate in rural areas. One study from Nursing Outlook found that:

“States granting NPs greater SOP [scope of practice] authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP.”

 Another study performed at Montana State University found that:

“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.”

NPs simply want to use legislation – not the education or training needed – to earn the privilege of practicing medicine.

Nurse practitioners don’t want to practice medicine — they want to practice nursing. That’s why many of them have spent tens of thousands of dollars and years of their lives to earn Doctor of Nursing degrees. Nurses treat specific ailments, like a general practice physician, but their treatment philosophy also encompasses the health and well-being of the individual as a whole.

If a physician has an agreement with an NP, but isn’t providing any real supervision, that physician needs to be reported to the board.

That argument isn’t really related to the issue of full practice authority. Rather, it’s a talking point the physician community uses to distract from the issue of utilizing full practice authority to increase access to care for all Oklahomans. The fact is, several nurse practitioners already own their own clinics in Oklahoma, and many more are providing services to Oklahomans every day with little or no oversight from their collaborating physicians. In fact, the law doesn’t even require oversight — it only requires a signed collaborative agreement. The problem is that NPs might pay thousands of dollars every month for that agreement. Those are funds that could be used to open new clinics, hire additional staff — or just considered income for work performed. Nurse practitioners are nationally certified and regulated by the Oklahoma Board of Nursing. The requirement for collaborative agreements is simply outdated red tape that is holding back health care in Oklahoma.

That should be common sense. Who would build or relocate a business where their employees have little or no access to health care? Common sense was borne out in a study that is part of a statewide initiative called the Kansas Rural Health Works program sponsored by the Kansas Hospital Association.

We know that full practice authority for nurse practitioners will increase access to health care, and that means an improvement in the health and wellbeing of residents. But it turns out that health care access is also a vital economic statistic.

Dr. John Leatherman, agricultural economist at Kansas State University’s Office of Local Government and lead author of the report, noted that health care access and education are two of the most important factors in attracting and retaining business and industry.

“Research has shown time and again that local health care and education are two enormously important factors for economic development,” Leatherman said, “and both can be positively or negatively influenced by local action or inaction.” He said the local health care system has sometimes been the “tie-breaker” in industry location decisions and that retirees view quality local health care as a “must have” local service.

Kansas isn’t the first of Oklahoma’s neighbors to argue that quality health care is a good prescription for economic development. Last year, Ben Hammond, president and CEO of the Texas Association of Business, penned an opinion piece in support of full practice authority for the San Antonio Express-News.

The reality is our state does not have enough health care providers to meet our population’s needs. Texas ranks 47th among the 50 states in primary care access. And while Texas is busy worrying about whether APRNs should have to pay doctors to practice, other states like New Mexico are happily recruiting our Texas-trained APRNs to come to them. Why wouldn’t an APRN go to a different state where their competitors aren’t allowed to deny them the right to practice?

That sounds strikingly similar to Oklahoma, except we rank 49^th in physician-to-patient ratio. We all know the need, and studies have shown that nurse practitioners are more likely to set up shop in rural areas.

HB 1013, by Rep. Josh Cockroft and Sen. AJ Griffin, would allow nurse practitioners to put their full education and training to use caring for Oklahomans. That bill passed the Oklahoma House with an overwhelming, bipartisan vote before stalling in a Senate committee. The measure isn’t dead, though, and can move forward once the legislature reconvenes in February.

In addition to researchers in neighboring states, a number of free-market think tanks have pointed to the advantages of full practice authority. Current regulations, in many states, include burdensome red tape that does nothing to improve patient safety or outcomes. Jettisoning outdated regulations would improve health of both the citizens and the business environment. It’s a move that Oklahoma should make sooner rather than later.

In Oklahoma, more than 1 out of every 3 people you pass in the store or sit with in a movie theatre or restaurant are on a path to developing diabetes. Most of them don’t even know it.

That’s why awareness and early diagnosis are critical. Once diagnosed with diabetes, there is no cure. Many of our friends and neighbors are not aware of their risk, though Oklahoma has one of the highest diabetes rates in the nation.

According to the American Diabetes Association, approximately 451,888 Oklahomans, or 14.3 percent of the adult population, have diabetes. More than 1 million Oklahomans – 36.9 percent of the adult population – have prediabetes. 

In my work as a diabetes care specialist, I see every day how dangerous and painful diabetes can be if it’s undetected, untreated or uncontrolled. It’s not a problem that goes away. If left untreated, it only gets worse and could lead to blindness, amputations and more.

The disease sometimes shows few symptoms at first, but early diagnosis is key to successful treatment and avoiding serious complications in the future. Though there is no cure, healthy lifestyle habits can help to successfully manage the disease.

Everyone can reduce their risk and even those with prediabetes can slow its progress with a few simple steps.

Actions like eating a healthy diet, exercising regularly and maintaining a healthy weight are key. Controlling cholesterol, watching for high blood pressure and not smoking also reduce your risk.

Early detection is vital. If you have risk factors for diabetes, it’s important to have your blood glucose level tested. Make an appointment and chat with a medical professional today.

Diabetes is a problem that you can’t start treating soon enough.

Leah Melton is a nurse practitioner specializing in diabetes care. She is board certified in Advanced Diabetes Management through the American Association of Diabetes Educators. She practices in Norman.

Now the Oklahoma City VA is moving closer to putting those rules into practice.

Officials said the Oklahoma City VA is on the cusp of granting full practice authority to more than three dozen advance practice registered nurses.

Kerri Craft, associate director for patient care services at the Oklahoma City VA, and Siobhan Gower, credentialing and privileging supervisor at the local VA, explained that officials at the Oklahoma City Veterans Center has been amending their clinical bylaws and setting up the privileging process for nurse practitioners to be granted full practice authority.

“We’ve got 38 APRNs in our center, and our hope is to get all of them through the privileging process in the next few months,” Craft said.

Gower said that the privileging process for nurse practitioners will work much in the same way that it currently does for physicians.

“There are standardized privileging forms for different areas of concentration, like primary care, medicine and so on,” Gower said. “That form will be approved by a professional standards board and then it’ll go to the director of the center for final approval.”

Craft and Gower also said that pay scales have been adjusted. Nurse practitioners have the opportunity to make more once they move through the privileging process.

“We really hope that moving from a scope-of-practice approach to a privileging process with be a good recruiting tool,” Kraft said. “We’re looking to hire a number of additional APRNs from across the country in the coming years.”

That’s following a recent trend of using nurse practitioners and other APRNs to increase access to health care. In addition to the move at the VA to grant full practice authority to nurse practitioners, 22 states and the District of Columbia grant full practice authority to NPs, and the list continues to grow every year.

There are nearly 6,000 advance practice registered nurses who work for the U.S. Department of Veterans Affairs, not to mention thousands more who care for veterans in other facilities.

But access to medical care, even to basic primary care services, can be limited as the U.S. faces a shortage of providers. This is especially true in rural areas and VA facilities are no exception.

Though the nation as a whole faces this shortage of primary care providers, the need is particularly acute in Oklahoma, which ranks 49^th among the states in physician-to-patient ratio.

Too many residents lack access to basic care, and simply put, the state faces a crisis in health care access. Nurse practitioners can be a part of the solution.

The VA is expanding the role of nurse practitioners and actively recruiting new hires to serve veterans. The Oklahoma legislature can give the same rights and privileges to the nurse practitioners who are serving Oklahomans in communities across the state each day.

Lawmakers will have that chance in the upcoming legislative session. House Bill 1013 would grant Oklahoma nurse practitioners full practice authority. The bill was passed overwhelmingly in the House last year, but now awaits a hearing in a Senate committee.

The Association of Oklahoma Nurse Practitioners wrapped up a successful 23^rd annual conference on Oct. 20 with a call for NPs to continue their advocacy for increased access to health care for Oklahomans.

“You are your own best advocate,” said Peter Jeffries, AARP national engagements director. “Go into meetings with legislators and tell your story about why we need full practice authority in Oklahoma. Access to care is critical, especially in small towns, rural communities and underserved areas.”

In all, nearly 400 nurse practitioners and students from Oklahoma and surrounding states attended the conference at the Sheraton-Reed Conference Center in Midwest City.

An Oklahoma House measure introduced in the 2017 legislative session, House Bill 1013 by Rep. Josh Cockroft and Sen. AJ Griffin, would have done away with the outdated requirements that restrict access to care from NPs.

“We are so grateful as lawmakers for the impact you have on everyday Oklahoma,” Cockroft told the conference. “There are tremendous challenges facing Oklahoma, particularly in health care and access to care, but I can breathe easier knowing you’re out there doing your work caring for Oklahomans.”

HB 1013 passed the Oklahoma House of Representatives on a 72-20 vote, but failed to receive a hearing in the Senate Health and Human Services Committee. That measure is still active and could be taken up in the 2018 session.

Griffin praised the nurse practitioners for their work in communities around the state.

“Nursing is a special calling,” she said. “Thank you for what you do for your neighbors and your communities. I hope we can make legislative changes to allow you to work at the top of your skill level. Rural Oklahoma needs you. We need you and your expertise.”

The conference also featured workshops and seminars on a range of health care topics, including respiratory infection, insulin therapy, sports medicine, infectious disease and more.

AONP President Toni Pratt-Reid said she is optimistic looking ahead to the 2018 legislative session.

“Each legislative session, we learn a little bit more about the legislative process, and the public and lawmakers learn a little bit more about what nurse practitioners do each day and how we can do more to care for Oklahomans,” Pratt-Reid said. “Our annual conference is a great opportunity to share what we’ve learned in the past year, and lay the ground work for the next year.

“We’re energized and ready to share our story with legislators and the public to keep building support for a measure that would increase access to health care for everyone in the state,” she continued. “Everyone in Oklahoma would benefit from full practice authority, and more people are starting to understand that every day. We can increase access to affordable care for Oklahomans without spending a dime of taxpayer money. It’s a win-win.”

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.”

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!”  

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 49^th 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.

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.

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 46^th. Of the 22 states with full practice authority, New Mexico had the lowest ranking at 38^th.

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.

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.

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.

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.

We’ve cleared the next hurdle on the track to full practice authority! HB 1013 passed the Oklahoma House of Representatives on March 1 by a 72-20 margin. That success was due in no small part to your hard work and all those who made the time to visit legislators during our annual Legislative Day at the Capitol. Thank you!

On Feb. 14, several dozen NPs and APRNs attended and engaged with legislators to explain and advocate for this legislation. Attendees heard from speakers including Sen. AJ Griffin, who is the Senate author of House Bill 1013. AONP President Toni Pratt-Reid and AONP Executive Director Benny Vanatta shared an update of our progress and the status of HB 1013.

We also heard from Mary Overall, a member of AARP Oklahoma’s Executive Council and a retired registered nurse and former CEO for Central Oklahoma Carelink, who noted, “The role of the advanced practice nurse is important. You are a leader and an advocate in seeing that Oklahomans get the care that they need.” The AARP also had several volunteers out talking to legislators and supporting the measure.

Our legislative day at the Capitol garnered news coverage on both Oklahoma City and Tulsa TV stations, and the day was covered in newspapers across the state. We are hopeful that this momentum will continue to grow as the legislative session continues this spring!

Don’t let up because there is still work to be done. Our attention now turns to the state Senate. If you haven’t yet spoken with your state senators, take some time to engage today. Our blog about preparing for the legislative session includes tips for connecting with your legislators and information about other AONP resources to utilize. When you call their office, be sure to request a return call and offer to answer questions or address any concerns. We hope you will continue to advocate for increased access to health care for all Oklahomans! 

House Bill 1013, sponsored by Rep. Cockroft, would allow nurse practitioners (NPs) to practice to the full extent of their education and prescribe medications consistent with their training. This would give Oklahomans in rural areas and across the state more health care choices for themselves and their families. The measure would do away with the antiquated requirement that NPs pay for “collaborative agreements” with a physician, even though little or no collaboration actually occurs.

Twenty-one states and the District of Columbia already grant full practice authority to nurse practitioners. In fact, the U.S. Department of Veterans Affairs recently granted full practice authority to nurse practitioners working in V.A. facilities, trusting them to do their part in caring for the heroes who have served our country.

The benefits to Oklahoma are obvious. Of Oklahoma’s 77 counties, 64 are designated as primary care Health Professional Shortage Areas, state Health Department statistics show. Our state is ranked 49^th in physician-to-patient ratio. That means Oklahomans in rural areas are driving long distances and spending hours in waiting rooms for primary care services.

We can do better.

A nurse practitioner is a registered nurse who is prepared, through advanced education, including completion of a master’s or doctoral degree, and clinical training, to provide a wide range of preventative and health care services.

In Oklahoma, nurse practitioners practice with an independent license. They can provide physical examinations, diagnose and treat acute and chronic problems, interpret laboratory results and X-rays, provide training and supportive counseling on the prevention of illness, and refer patients to other health professionals as needed.

Nurse practitioners are also educated to prescribe and manage medications, though NPs in Oklahoma must pay for a collaborative agreement with a physician to do so, even though the physician does not review patient charts or supervise care.

Nothing in HB 1013 would change nurse practitioners’ scope of practice. What the bill would do is cut through red tape that limits the number of NPs practicing in Oklahoma and places an unnecessary financial burden on the ones who do.

There is a health care crisis in rural Oklahoma, but the legislature can take action this year to bring quality health care closer to the Oklahomans who need it.

Thousands of Oklahomans already trust nurse practitioners for their primary health care needs. Lawmakers can make this option even more readily available to all residents of our state. Full practice authority means shorter drives and less wait time, greater consumer choice, less government red tape and, most of all, a healthier Oklahoma.

Please call or email your state representative today and ask them to support, or even better, to co-author HB 1013. If you’re unsure who represents you at the state Capitol, you can find out here.

The legislative session commences in a little more than a month. Session officially begins on Feb. 6, but there is much we can do before then. Rep. Josh Cockroft has already requested that a bill seeking full practice authority be drafted, so now is the time to begin talking to legislators about full practice authority. Personal connections are key to our success in achieving our legislative goals in 2017.

Don’t underestimate your influence as you connect with legislators. Legislators care about the issues raised by their constituents. Connecting with your legislators in person will make a difference. Before contacting your legislators, take time to research and learn about them, their voting records and their committee assignments. You can find your legislators’ contact information and background information on the Oklahoma State Legislature website.

The FPA toolkit for NPs is a great resource as you prepare to meet with legislators. The toolkit on the website includes tips for contacting your legislators, a white paper and talking points for full practice authority, a public speaking guide and PowerPoint presentation, a full practice authority infographic and more.

Last month we shared the full video of Katherine Hoebelheinrich, MS, APRN, presenting at the AONP Annual Conference. Watching her presentation is another great way to prepare for engaging legislators. She shared her firsthand experience of how nurse practitioners in Nebraska worked to secure full practice authority and she encouraged Oklahoma’s nurse practitioners to tell our stories to reveal the struggles NPs and their patients face.

We encourage you to establish relationships with your legislators now. Spending time sharing your story and illustrating the important role NPs play in their communities is the primary way to grow support during the forthcoming legislative session.

We will keep members updated throughout the next few months and during the legislative session via email and on social media (Facebook, Twitter, and Instagram). We would love to hear about your successes engaging with your legislators! You can connect with us and share your stories through the contact page on our website. 

The four pre-conference workshops covered diverse topics, including basic principles of suturing and a diabetic boot camp. The plenary sessions were led by medical professionals from diverse disciplines, and each session’s content was rich and informative. A few of the many topics discussed were diabetes, cardiovascular health, antibiotics and infectious disease.

Katherine Hoebelheinrich, MS, APRN, shared her firsthand experience with nurse practitioners in Nebraska working to secure full practice authority. She led the statutory Scope of Practice Credentialing Review that preceded NNP’s successful legislative initiative for full practice authority. 

Hoebelheinrich’s encouragement to Oklahoma’s nurse practitioners was to get to know our legislators and to tell our stories to illustrate the problems facing our profession and our patients. If you are interested in connecting with and supporting legislative candidates, be sure to read last month’s blog. 

Her address, along with the other speakers, continued to build our momentum toward the upcoming legislative season. David Holland, a past-president of AONP, reminded attendees “this is a great time to reach out to the candidates. Many don’t know the first thing about FPA. Educate them, gain their support.”

We look forward to pushing toward full practice authority and allowing nurse practitioners to work at the full scope of their education. You can watch Katherine Hoebelheinrich's full presentation in the video below. 

The simplest way to find the names of your local candidates is to visit the State Election Board’s website to view your sample ballot. You will be asked to type in your first and last name and your date of birth. Then you will see the sample ballot with the names of the legislative candidates for your district. Finding their contact information on a Facebook page or by using Google is usually pretty easy after that.

Reach out to the candidates in your district either by phone or by email and get to know them. Ask the candidates about full practice authority and other health care issues that are important to nurse practitioners. If the candidate does not know about the benefits of full practice authority, take the time to educate them. The FPA Tool Kit for NPs on our website might be helpful for you as you start to think about your talking points and help answer questions the candidate might have. Most importantly, share the reasons why you believe full practice authority is best for Oklahomans. 

Nurse practitioners offer a solution for affordable and accessible healthcare in Oklahoma and if your candidate seems to agree, let us know! Be sure to email AONP Executive Director Benny Vanatta.

Beyond that, offer to volunteer to help with their campaign. Every campaign needs good volunteers. This time of year, most candidates are out knocking on doors with volunteers every Saturday and many weekday evenings. We have a couple more dates scheduled to volunteer as a group and we would love for you to join us.  

1. We know you're originally from Africa. When did you move to the United States and why?

I am originally from Cameroon (West-central Africa) and my prior education was in French. I moved to the United States of America 15 years ago for a better future and standard of living for my family and me.

2. Tell us what it was like growing up with a father who is a Physician Assistant.

Growing up with a father who played a huge role in helping people with their healthcare issues was extremely inspiring. My grandmother also inspired me. She was a dedicated midwife. Most evenings and weekends, many of our neighbors waited on my father in my childhood home for assistance with their acute and chronic health issues. He joyfully helped everyone (mostly for free). His work ethic and his love for the work he did were contagious and selfless. Growing up with him, I always prayed to have the same energy, drive and dedication to help people in need.

3. What made you decide to pursue a career as an NP?

When I graduated from high school in Cameroon, there was only one medical school. Due to this limitation, it was a widely known fact that the admission process for the only medical school was corrupted and reserved only for famous and wealthy families. I applied twice but was unsuccessful despite being a qualified candidate. I was extremely disappointed. Following the advice of my college counselor, I majored in biochemistry with the hope to work in medical research upon graduation. During my second year in college, I also volunteered with non-profit organizations for the fight against Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS). I spent most weekends traveling to many villages educating the population about HIV/AIDS as well as other sexually transmitted diseases (STDs). When I moved to the USA, I worked as a research assistant. However, there was no fulfillment. I always felt like something was missing. After taking a few pre-requisites, I was admitted at Georgetown University where I graduated with a Bachelor of Science in Nursing. I worked as a critical care nurse, clinical informaticist and a performance improvement/quality nurse. However, the following motivated me to want to become an NP: - I am always eager to learn more because, in nursing, opportunities for personal and professional betterment are endless. - The U.S. population is aging, living longer and in need of more primary care services and providers. - I also want to become a change agent to help reform the healthcare system and bridge the healthcare gap in Cameroon.

4. What is your favorite part about being an NP?

There are several reasons I like being an NP. My favorite part is building long-lasting relationships with my patients. Also, I like the emphasis on healthcare prevention including holistic health education. When a person is treated as a whole, it leads to increased compliance and better outcomes.

5. What do you hope to do or see within your profession in the next 10 years?

NPs are compassionate, caring, skilled and capable of diagnosing and treating many acute and chronic conditions. I am hoping that NPs in the State of Oklahoma (just like 21 other states in our country) will have gained full prescriptive authority within the full scope of their practice. NPs are well educated, trained and ready to work independently from physicians. My personal goal is to graduate in two years with a Clinical Doctorate of Nursing from Oklahoma City University, work to gain more experience, be a part of health care policymakers and open my own clinic.

6. Tell us about the most rewarding experience you've had in your practice.

It is always a blessing to see patients recover from an illness or healthcare crisis, or seeing patients motivated to adopt healthy choices in order to maintain a healthy lifestyle.

7. What would you like to say to someone considering a career as an NP?

Go for it. The sooner, the better. There are many ways to impact the patients that entrust their healthcare needs to us. This also impacts the community in which we live in. In light of the global impact NPs can make, it’s more important than ever that our legislators give NPs the right to practice without the oversight of a physician. Change agents like Ferdie are the catalysts we need to advance the field and allow us to make a difference not only abroad, but also in our own backyard.

1. Why did you decide to pursue a career as an NP? 

I decided to become an NP after being a RN for more than 17 years. I saw a huge gap in psychiatric services being delivered to individuals in my community. Enid is not a small town, but it did not have adequate psychiatric services. There were plenty of counselors, but medication management was a huge gap. Local family doctors, NPs or physician assistants were left to manage psychiatric medications or individuals had to drive to Tulsa or Oklahoma City to see a psychiatrist or PMHNP. This left many adults and children with inadequate services for managing their psychiatric medications. This was my primary passion for deciding to return to school.  

2. How did you decide to specialize as a family mental health psychiatric NP? 

I knew that this was the one area of specialties that was lacking professionals. At the time I started school, I believe there were only about 12 NPs with psychiatric specialty training. 

3. How would you like to see your profession change over the next 10 years? 

I would love to see more NPs specializing in psychiatry. I believe that independent practice is essential for the role of NPs to be fully utilized in Oklahoma. Many states have already adapted to full practice authority. Oklahoma needs to work quickly on this. Independent practice would have allowed me to open a practice in Enid, Oklahoma.  Right now there is not a full time psychiatrist in Enid, which has kept me from expanding available services. The limited number of psychiatrists in our region limits expanding services under the current rules and regulations for NPs.

4. Tell us about the most rewarding experiences you’ve had in your practice. 

The most rewarding thing in practicing psychiatry is seeing an individual change emotionally and physically. I have had patients thank me for adjusting their medications to the point of being able to function better in society. Mental health treatment changes individuals. It can open the door for people who feared being around others to becoming a professional with a full time job. My patients make my job worth all of the stress on a regular basis. I love my job. 

5. You have a passion for the role NPs play in mental health and other specialties. Tell us about that.

The ability of NPs to specialize allows us to provide quality care in many areas of practice that are currently underserved. The specialty programs in NP training allow NPs to focus on certain areas of practice. This increases the number of specialists that are available in communities both urban and rural. Specialties are always needed especially in rural areas. I envision NPs providing more specialty services in the underserved areas in the future. This will increase access to care for patients, which is vital to keeping Oklahoma healthy. 

6. What would you like to say to someone considering a career as an NP?

Go for it. Be dedicated and determined to providing quality care to your patients. Know that it will take a lot of work, time and dedication to complete, but it is worth it. Being an NP has been a great privilege for me. My family has had to make a lot of sacrifices, but overall the job satisfaction is worth all of the struggles.  

Ellen has made it clear that rural health care is in crisis. There are not enough options for specialized health care, especially when it comes to mental health, in small towns and farming communities across our state. Patients have to drive too far to get their hands on the treatments and medications they need to live full and meaningful lives. Oklahoma’s shortage of rural specialty health care providers will only continue to limit access as populations grow. It’s essential NPs be granted the opportunity to build independent practices in their communities.

The Association of Oklahoma Nurse Practitioners has an important mission. We need to spread the news of the importance of nurse practitioners in the health care system. This is why we need you – we need your stories!

We all want a better health care system, and the power to change the system lies with the public and with our local legislators. When we have a wealth of stories illustrating how NPs are vital to the health care system, we can place the stories in front of legislators and the public.

If you have a story about helping a patient receive care who wasn’t able to see a doctor, we want to know your story. If you are giving care to patients in rural areas who are not able to see a physician, let us know. If you know a fellow NP who has gone above and beyond to help a patient, tell us about them.

If you are passionate about nurse practitioners having full practice authority, we want to hear you.

We intend to spread the message far and wide. We’ll use our blogs, newsletters and social media pages to publish your stories. We want everyone in Oklahoma to know how vital NPs are to health care in Oklahoma. Help us spread the message – send us your story today!

Nurse practitioners have always helped patients receive care more easily. Today, there is a growing gap between the number of patients who need primary care and the number and availability of primary care providers. Many patients are waiting longer than they should to receive care due to inaccessibility to primary care physicians.

Often, physicians decide in medical school to specialize. This has left a gap in the primary care setting and has presented an opportunity for advanced practice nurses. Although the advanced practice degrees include specialty pathways the most common are family and pediatrics.

The simplest and most obvious way nurse practitioners have been a part of the solution has been availability. Michelle Ellenburg M.S.N., R.N. with St. Anthony Hospital. “We definitely have quicker access. Everyone can get in to see a nurse practitioner eventually. I’ve had a handful of patients who have been referred to me from the E.R., who have had no primary care provider. One lady was diagnosed with diabetes while in the hospital. She had no access to any care, and she came in and saw me. We got her tools to monitor her diabetes, and in the last 6 months we’ve gotten her diabetes really under control!”

Many times the sheer speed of receiving care can make a significant impact. “When patients like her are able to get in to see me in the first couple of days after her hospital visit, I think that makes the difference. When people get big diagnoses like that, and on top of it you tell them, ‘these are the lifestyle changes you have to make’, it’s a bigger impact when you are able to tell them immediately after their diagnosis.”

We have already seen the impact of nurse practitioners on the health care systems of rural areas. Michelle Ellenburg had quite a few friends that she graduated with at the University of Oklahoma who were from rural areas and all went back to their own communities. “Just talking with them briefly since then, you can tell that they’re really busy. I’m getting busy, but I’m in the city, and there are a lot of care providers to see. They’ve all been crazy busy because there are so many people that need health care who haven’t been able to receive it before. Or their patients were driving long distances to receive care, and now they are able to get care in their own communities. Nurse practitioners are definitely filling that gap.”

Not only are nurse practitioners more available, but also their bedside manner is impressive. “Nurse practitioners are great, specifically more holistic… we spend more time getting to know you and understand why you make the decisions you’re making. Like maybe you can’t afford your blood pressure medication, so we do a good job of help people getting resources like that, so I think we’re awesome. Almost all of my patients say, ‘You know, it’s so nice to feel like I’m heard’. I feel like I’ve heard that a lot lately. That is because, you know, I worked along the bedside, and I was trained as a nurse, and that’s just usually our mannerisms.”

Nurse practitioners are more available, uniquely qualified and carefully trained in bedside patient care. As health care advances across the country, nurse practitioners will continue to play a vital role in primary care.

As you know, Medicaid rates are on the verge of being cut an additional 25 percent due to the state’s budget shortfall.

That would bring rates down to 61 percent of the Medicare rate. Even if you are not personally reimbursed by Medicaid, this rate cut will negatively affect every individual and every community across Oklahoma as hospital and clinics are forced to lay off staff or shut their doors.

As we’ve been urging, we need you to write your legislators! Ask them to support the Medicaid Rebalancing Act and to vote in favor of the tobacco tax increase. If you don’t know who represents you in the legislature, you can find that information here.

AONP is working with the Oklahoma Nurses Association to encourage legislators to support the proposed Medicaid Rebalancing Act. Nico Gomez met with us several weeks ago to discuss this proposal, and that presentation can be found here.

Make your letters as specific and personal as possible. Here are some questions to consider:

·      How long can you endure these cuts and still provide services?

·      What percentage of your patients are on Medicaid?

·      How many of those are children, young mothers, the elderly or disabled?

·      How many jobs might be lost as your workplace absorbs the cuts?

·      How will this affect access to care in your community?

·      Where will your neighbors seek medical care and how far will they have to drive for primary, emergency or specialty health care?

·      If the local hospital or clinic is forced to close, how will this affect other businesses and the community as a whole?

One in every 3 Oklahomans is enrolled in Medicaid. These cuts will be catastrophic to the health care infrastructure in Oklahoma. We must act, and we must act quickly, to educate lawmakers about the consequences of these cuts and motivate them to work together to find a solution!

We saw so many APRNs help represent us at the Oklahoma State Capitol, but we also understand that much of the work APRNs do in Oklahoma happens in all corners of the state. To help build solidarity amongst APRNs across the state, AONP has scheduled town hall meetings in nine cities across Oklahoma.

These meeting will give APRNs the opportunity to visit with colleagues from throughout their region and get the latest information on legislative issues and updates on the plan for next legislative session. We will also discuss Medicaid proposals from the Oklahoma Health Care Authority, AONP membership, grassroots lobbying and answer your professional and political questions.

Invite all of your APRN friends. These meetings will be open to all APRNs regardless of whether or not they are AONP members.

Board members will attend the meetings at all nine locations, as well as Benny Vanatta, AONP Executive Director and lobbyist. Find a meeting location near you below:

Dates and times of the meetings are:

Enid

6 to 8 p.m.

April 21

Holiday Inn Express, 4702 W Owen K. Garriott

Click here to register

OKC

6 to 8 p.m.

May 5

Holiday Inn Express, 3840 W Second St., Edmond

Click here to register

Bartlesville

6 to 8 p.m.

May 18

Holiday Inn Express, 4106 SE Price Road
Click here to register

Tulsa

6 to 8 p.m.

June 9

Holiday Inn Hotel, 10020 E 81stSt.

Click here to register

Lawton

6 to 8 p.m.

July 14

Holiday Inn Express, 209 SE Interstate Drive

Click here to register

McAlester

6 to 8 p.m.

July 21

Holiday Inn Express, 1811 S Peaceable Road

Click here to register

Weatherford

9:30 a.m.

Aug. 13

Holiday Inn Express, 3825 E Mail St.

Click here to register

Idabel

6 to 8 p.m.

Aug. 25

Comfort Suites, 400 SE Lincoln

Click here to register

Woodward

6 to 8 p.m.

Sept. 1

Holiday Inn Express, 3333 Williams Ave.

Click here to register

Any APRN in Oklahoma may attend any or all of the meetings they desire. We will see you there!

Ryan is an active 7-year-old boy. If he’s not studying moves in his Jiu Jitsu class, you might find him playing with his dogs or near a Minecraft controller.

Ryan’s mom Amber Knapp is what you might call a health nut. As a beachbody instructor and personal trainer, she is the kind of person who watches the health and wellness of her family very carefully. You shouldn’t be surprised that, for her son’s primary care provider, Amber turns to a nurse practitioner.

Mrs. Knapp has a friend who is a nurse practitioner and says, “Having seen the amount of studying and work she completed to become an ARNP was one reason I feel completely confident with her as our provider.”

This 2008 study on the quality of care provided by nurse practitioners compared to doctor-provided care confirms her personal findings. The results point to the conclusion that patients are generally more satisfied with their care from a nurse practitioner than that of a doctor.  http://apps.who.int/rhl/effective_practice_and_organizing_care/SUPPORT_Task_shifiting.pdf

Quality of care is important to most people, and nurse practitioners are known to be generally more available than doctors. As Amber Knapp says, “I feel that NPs are more accessible than MDs. They seem to be more patient-focused and spend extra time to ensure the patient is at ease.”

Many moms across the state go to a nurse practitioner as their primary care provider, and many are in favor of full practice authority. Mrs. Knapp stated,

“I would agree with full practice authority. When my son’s general practitioner retired, I started taking him to see a pediatric nurse practitioner. I was very impressed with how much more thorough the exam process was and how much thought and care she put into the assessment and his well child check. It was our first visit with an NP and I feel she went above and beyond the basic exam. She calmed my nerves as a parent and answered all my questions without seeming like I was intruding on her time.”

“She is more than willing to take phone calls and answer questions anytime. If she is unavailable, she makes sure we can be seen ASAP with another practitioner in her clinic. I would very much recommend a nurse practitioner as a primary care provider. I have had nothing but great experiences with our NP.”

There are many caring mothers in Oklahoma who also choose a nurse practitioner for primary care. If you are one of those moms, tell us your story! Contact us and follow our Facebook page to join a community of NPs and supporters.

Sources:

http://apps.who.int/rhl/effective_practice_and_organizing_care/SUPPORT_Task_shifiting.pdf

http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/APRNs-as-PCPs.pdf

http://kff.org/medicaid/issue-brief/tapping-nurse-practitioners-to-meet-rising-demand-for-primary-care/

http://www.aacn.nche.edu/downloads/aacn-future-task-force/Inglehart-PC-Article.pdf

As many of you have heard, HB 2841 has been assigned to the Appropriations and Budget (A&B) Health Subcommittee. So far, Dr. Doug Cox has not agreed to hear the bill, but we still have time to speak with legislators before the deadline. We currently have almost 20 co-authors and we ask that you continue to reach out to your state representatives. The more co-authors we have, the better chance we have of our bill being heard. We are not going to give up on full practice authority!

Many of our AONP members have been asking questions about the bill and the best ways to help the bill. We’ve put together a list of frequently asked questions about HB 2841, and an update of its progress.

Who are the co-authors of HB 2841?

We have had many requests for a current list of co-authors for HB2841. The path of a bill and the paperwork and verification of the process surrounding it takes time. The list of co-authors will continue to change as more representatives agree to sign-on. Bear with us as we try to keep this list current. You can view the most updated list of co-authors here, or check in on our AONP Facebook page.

What hospitals and other organizations support HB 2841?

So far, the current list of hospitals and organizations that support HB 2841 includes St. Francis Tulsa, St. Anthony OKC, Tulsa University School of Nursing, Southwestern Medical Center, St. John Trauma Center and Duncan Regional Hospital. Visit our updated list of supporters for the latest update to this list.

When is the deadline?

The deadline for reporting House bills and joint resolutions from House committees is Friday, Feb. 26.

How can I help?

Right now, contacting your state representatives and explaining the importance of HB 2841 is the best thing you can do. After talking with a legislator, let Benny Vanatta know, so he can follow up with that legislator.

Is there anything I should avoid doing?

Avoid negative or sarcastic speech that can be seen as offensive. Also avoid creating additional messaging platforms that can confuse the public. We want to present a united front against the opposition of this bill, and to do that we need to stick to official messaging and lobbying efforts.

What is our AONP leadership doing to help?

Our leadership has met with many members of committee assigned to the bill, including Dr. Cox himself. We have met with many organizations including the Oklahoma Rural Hospital Association, Oklahoma Health Care Authority and many of Oklahoma’s legislators. We will continue to promote HB 2841 at the Oklahoma Capitol and across the state.

We appreciate your continued help in fighting for the #RightToPractice.

We’ve hit our first challenge and need your help! Our bill allowing for full practice authority, HB 2841, is assigned to the Appropriations and Budget (A&B) Health Subcommittee, chaired by Rep. Doug Cox. So far, Rep. Cox has not agreed to hear the bill. This is discouraging, but we still have three weeks to do everything we can to get that bill out of committee.

We currently have almost 20 co-authors and we ask that you continue to reach out to your state representatives. The more co-authors we have, the better chance we have of our bill being heard. Don’t forget to also contact your local hospital administrator to ask for their support. We are not going to give up on full practice authority!

Remember that even if you disagree with a legislator, respect and courtesy are vital. We want legislators to be our friends and help us. A legislator will always defend one of their colleagues, so attacking one may turn others against our cause.

Letters to legislators work best when they have a personal touch, but to get you started here's a letter template. To find your local House member, follow this link: http://www.oklegislature.gov/FindMyLegislature2.aspx?State=OK.

Working together, we can bring this issue to the attention of all our legislators and improve every Oklahoman’s access to quality, affordable care.

Best,

Benny

 

Damarcus Nelson has been selected  to receive the AANP Advocate State Award for Excellence. This prestigious award is given annually to a dedicated NP advocate in each state who has promoted the NP role and patient access to care. 

"This recognition from American Association of Nurse Practitioners is not only an honor but, a privilege to be mentioned in the same breath with providers that have pushed our profession forward. The award will be given at the upcoming AANP national conference in San Antonio, TX June 24, 2015. I'm very excited to represent Oklahoma health care and my fellow NPs in our fight for full practice authority in the state. This award has made my fire for pushing our profession even stronger and will continue to make me a better provider in years to come. Thank you to those who have supported me along the way and continue to help Oklahoma NPs be elite healthcare providers." - Damarcus Nelson

Damarcus Nelson has been practicing in Oklahoma since 2012 with Family Healthcare and Minor Emergency. "We service a large area of patients from Piedmont to Oklahoma City.  Currently we have three clinics to service the surrounding patient population.  Our practice is NP owned and operated. We see a large amount of Soonercare, commercial, and DDSD patients. Currently I act as a lead provider and many patients call me their PCP (primary care provider). I wake up everyday loving what I do and treating every patient like they are family. I welcome what the future has in store for NPs throughout the state of Oklahoma." 

We congratulate Damarcus Nelson and share in the excitement for what the future has in store for NPs throughout the state of Oklahoma!

We have had many people ask us lately, “How can I help advance AONP?” The number one way you can help Nurse Practitioners across Oklahoma is simply to tell your story of how NPs help improve health care in Oklahoma. A first-person story is always the best way to connect with someone on an issue. 

Keep it Local

If you’d like to share the advantages of NP care to your state, reaching out to your local community is relatively easy to do. Perhaps you could invite a local or state government official to tour your practice.

Reach out to existing civic groups in your community to add the topic of NP care to discussions at chambers of commerce, business groups, schools, PTAs and other community forums. You could organize a health fair with your local NP group, and reach out to local public venues that might be interested in hosting such an event.

With your practice or your local NP group, support a local non-profit organization. Encourage healthy physical activity by sponsoring a fun-run, where proceeds benefit a local non-profit organization. Build positive ties in your community, and your voice and message will be respected.

Deliver the Letter

If you have a knack for writing, you might want to think about writing a letter to the editor of your local newspaper. Letters provide a public forum to open up a discussion with the public. Remember to include all pertinent contact information, as the newspaper will want to contact you to verify the article.

Be timely in your response to news events. Be clear in your language, and focus on one main point. Get your readers’ attention at the beginning of the article with an interesting fact, and then keep their attention through about three paragraphs.

Show respect to your readers and avoid personal attacks or rudeness. A letter to the editor is meant to be of an opinionated nature, but should be strongly backed up with facts. Check and recheck for grammar and spelling mistakes. Hand it off to a friend or family member for additional proofreading. Read several letters to the editor before you begin writing yours to assess the publication and their editors’ tastes.

If your letter is not published, don’t worry or be discouraged.

Online Outreach

The internet is the largest discussion forum that exists. Share good news about NP care in the online groups that you are already a part of. To maximize the community of peers that you share ideas with, check out some of these existing online resources for NPs:

Like and follow AONP’s Facebook Page

Follow AONP on Twitter

Visit the AONP website

Follow AONP on Instagram

Visit the AANP website

Join AANP’s LinkedIn Group 

Visit AANP on YouTube, Instagram and Pinterest.

No matter the venue you choose to share the impact of NP health care, speaking up is the important part. Join us as we aim to show the entire state of Oklahoma the importance of NP health care.

 

We are reaching a rural health care turning point

With about 175 doctors for every 100,000 residents in Oklahoma, the second lowest ratio in the country, Oklahoma is in the midst of a health care turning point.

State Impact’s Joe Wertz tells the story of rural Oklahoma and its small, but dedicated team of health care professionals. “When it comes to primary medical care, all but six of the state’s 77 counties have ‘medically underserved’ populations, according to the U.S. Department of Health and Human Services. Nine counties — in their entirety — have been designated Health Professional Shortage Areas. The shortage hasn’t gone unnoticed by lawmakers.”

Why is there a medical shortage in rural Oklahoma communities?

A combination of factors form the barrier to providing care to those citizens away from city centers. “Training location makes a big difference in medicine,” points out Rick Ernest of the Physician Manpower Training Commission. “If you want a rural doctor, you have to train them in a rural area,” he says, citing research showing most doctors end up practicing within 50 miles of where they were trained.

“The course of most young doctors has been established by the time their residency ends,” says Robert Valentine, a medical resident at the University of Oklahoma College of Medicine in Oklahoma City. “If they aren’t committed to rural care by then, it’s too late,” he says.

More rural residency programs would also help train doctors who are already committed to the idea of working in a small town setting. Oklahoma only has a handful of residency programs, the majority of which are in metro areas.

Perhaps the biggest factor is the power of cash. Medical students graduate with an average of $140,000 in debt, and instead of setting up a family practice in rural Oklahoma, most physicians are tempted to become a specialist, which can be a more lucrative position.

How can nurse practitioners reach these communities?

Nurse practitioners (NPs) can help meet the primary health care needs of these rural consumers, but outdated state scope of practice laws are keeping NPs from practicing to the full extent of their education and training, making it harder for patients to get the care they need.

Oklahoma law requires a supervising or collaborative agreement between each NP and a physician for prescription coverage. This law does not require a physician to sign off on any of their prescriptions. Physicians must make themselves available for collaboration, according to the Oklahoma Nursing Practice Act. NPs independently order lab work, x-rays and other diagnostic tests without any additional requirement of a physician input and may refer patients to specialists as needed.

In many instances a physician may never participate in the practice of an NP. The requirement to practice is hindered by the need to find a physician who is willing to serve as a supervising physician. The supervision is a signed form that satisfies the requirement of the Oklahoma Board of Nursing for prescriptive authority but does not alter the practice of the NP. Often times these supervisors practice several counties away from the NP office and are limited to supervising only two full time NPs. The cost to obtain a supervising physician to complete the required documents and be available for collaboration may run annually $20,000 to $50,000 of un-reimbursable costs to the NP. “These laws and regulations restrict the care NPs can provide, particularly in underserved rural areas where no physicians may practice.” –Campaign For Action.

In summary, allowing NPs to practice at the full extent of their education and eliminating collaborative agreements would save each practice thousands of dollars, decreased red tape for certain orders and improve overall access to healthcare. Many states have already taken action.

States who have taken action

North Dakota faced experiences very similar to our situation in Oklahoma due to the influx of energy workers in the oil and gas business in North Dakota’s rural areas. Those new consumers combined with the existing rural population caused expanded demand for health care that went unanswered because of limited access.

The main barrier to providing care to these North Dakota citizens was the requirement that NPs had to form a collaborative agreement with a physician to prescribe medications similar to the current situation in Oklahoma. Even when North Dakota NPs desired to practice in these underserved rural areas, many areas simply had no physicians in the area available.

In 2011, the governor of North Dakota enacted a law that allowed NPs to prescribe medications without restrictive physician oversight. The strategy seems to be working. The number of NPs in North Dakota has increased from 650 in 2011 to more than 1,000 today.

Nevada passed a similar law to North Dakota’s in 2013. Debra Scott, MSN, RN, FRE, executive director of the Nevada State Board of Nursing, explains how before the law was passed, few NPs were working in underserved rural areas, which meant that some patients had to drive one to five hours for care, Scott said. “Research shows that patients receive the same quality or better quality care from NPs as they do from physicians,” she said. “It’s been a wonderful way to recruit NPs to Nevada and meet the needs of people in rural areas, as well as those who are now covered by health insurance.”

To date, only 21 states and the District of Columbia allow NPs to practice to the full extent of their education and training.

What does Oklahoma’s future hold?

So where does this leave the state of Oklahoma? This November, Rep. Jon Echols initiated an interim study on “Expanding Access to Primary Care for Oklahomans and the Role of the Nurse Practitioner” to the House Public Health Committee. Over 60 NPs were present to give testimony and support on the issue. The public is passionate about this issue, and lawmakers have been taking notice.

Join the AONP as we will be putting up a fierce fight in 2016 for the #RightToPractice. We look forward to becoming the next state to give full practice authority to NPs.

Sources: https://stateimpact.npr.org/oklahoma/2012/03/01/the-cause-and-cure-of-oklahomas-doctor-deficiency-might-be-money/

http://campaignforaction.org/news/more-states-removing-barriers-nursing-practice-and-care 

http://kff.org/medicaid/issue-brief/tapping-nurse-practitioners-to-meet-rising-demand-for-primary-care/

http://oklahomawatch.org/2015/05/12/health-providers-budget-squeeze-could-shutter-rural-clinics/

http://oklahomawatch.org/2013/08/31/the-doctor-is-not-in/

http://www.grandforksherald.com/accent/health/3674436-nurse-practitioners-expand-access-health-care-services-especially-rural-areas

http://netnebraska.org/article/news/1002094/nurse-practitioners-ready-step-rural-health-gap

_​Oklahoma Celebrates NP Week and 50 Year of Nurse Practitioners

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