The Important Role and Challenges for Nurse Practitioners in Kentucky Healthcare

Kentucky has one of the highest rates in the nation for chronic disease such as heart disease, hypertension, and diabetes. At the same time, almost half of Kentucky counties are designated health professional shortage areas (HPSAs). This can mean lack of the most basic healthcare for people in those areas.  Family nurse practitioners (FNPs) are educated in management of these and other chronic diseases in the primary care setting. They also place a strong emphasis on health promotion and disease prevention, which is increasingly important. Family nurse practitioners have helped filled the gap in access to safe, quality healthcare in Kentucky, and nationwide, making them extremely important members of the healthcare team.

A Valuable Resource to Underserved and Rural Communities

Family nurse practitioners are an especially valuable resource to underserved and rural communities. Many FNP graduates chose to pursue their degree due to their desire to make a difference in their home community. They complete their advanced nursing practice degree and return home to practice. For many EKU students, “home” is also a rural or underserved community. Consequently, many of our graduates establish a practice with underserved populations. These are areas which continue to have difficulty attracting primary care physicians and face a critical shortage of health providers.  Of students completing EKU’s FNP program in May 2021, 61% indicated they would practice in an underserved area, the majority of those were students were from Kentucky. 

Additional Barriers to Needed Care

Unfortunately, barriers remain that prevent practicing to the full scope of FNP nurse education and training. This is especially concerning in areas where FNPs are most needed. FNPs in Kentucky practice independently, may even open their own private practice, and have been safely prescribing routine medications since 1996 and controlled medications since 2006. Yet in Kentucky, the requirement still exists to have collaborative agreements for prescriptive authority with a physician in order to prescribe routine medications (CAPA-NS) and controlled medications (CAPA-CS). The agreements do not require oversight by the physician. They simply state the physician will be available for collaboration when necessary. This creates the burden of locating a physician willing to enter into the agreements and paying any associated agreement fees.

The Drug Enforcement Agency (DEA) requires a CAPA-CS for a license. A DEA license is necessary to order critical medical supplies, such as vaccines and injectable antibiotics. It is virtually impossible for  FNPs without a CAPA-CS to open their own practice without the ability to obtained needed supplies, whether or not they intend to prescribe controlled substances.  For many rural or underserved communities dependent on nurse practitioners for their health care, this requirement directly and negatively impacts patients and access to healthcare.

While all indicators point to a continued strong and growing need for FNPs in Kentucky, as well as across the nation, rural and underserved areas continue to have the highest demand. Removing practice barriers such as prescriptive authority agreements allows FNPs to be utilized to the full potential of their education and training. Allowing them to better meet the healthcare needs of the Kentucky communities they serve.

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By: Dr. Margaret Zoellers, associate professor and the Rural Health Family Nurse Practitioner (FNP) program coordinator at Eastern Kentucky University’s School of Nursing.

Dr. Zoellers earned both her MSN and DNP from Eastern Kentucky University. Dr. Zoellers is a practicing APRN with over 24 years of advanced nursing practice experience, primarily in family practice but also women’s health, internal medicine, urgent care, and university student health.