Oklahoma governor vetoes bill on independent prescribing authority for APRNs

Oklahoma Gov. Kevin Stitt on March 29 vetoed a bill that would allow advanced practice registered nurses to prescribe certain medications without the supervision of a physician. 

Senate Bill 458 would have enabled nurse practitioners who meet certain criteria — such as having completed at least 2,000 hours of practice with prescriptive authority under the supervision of a physician — to apply for independent prescriptive authority for Schedule III through V medications. The legislation had previously passed the Oklahoma House and Senate. 

"Although I am aware of the state's healthcare access and workforce challenges, especially in rural communities, SB 458 is not a prudent solution," Mr. Stitt said in his veto message, as reported by local news outlets

"SB 458 would do one primary thing: enable Advanced Practice Registered Nurses (APRNs) who meet certain criteria to apply for authority to prescribe independent of physician supervision," the governor said. "And that's my biggest concern. While APRNS already have the ability to set up clinics in rural Oklahoma and practice in primary care settings, I don't believe APRNs should be able to prescribe Schedules III through V controlled substances without physician supervision. Further, this bill would allow APRNs to have full practice and prescriptive authority in all specialty categories absent supervision."

The governor pointed to certain elements of the bill that he said were "good" and should be explored further, including governing supervision requirements and imposing a reasonable limit on the amount a physician may charge for supervision. 

The bill's authors and other advocates had said it was meant to increase access to healthcare, particularly in rural parts of the state where there are few physicians. Meanwhile, the Oklahoma State Medical Association had opposed the bill, arguing it may do the opposite. 

"In other states where we've tried this, the nurse practitioners in rural areas actually leave those areas and to go the urban areas, unfortunately," Diane Heaton, MD, president of the state's medical association, told CBS affiliate KOTV-DT

Twenty-seven states and Washington, D.C, grant nurse practitioners full practice authority, according to a map that tracks state practice regulations from the American Association of Nurse Practitioners. Another 12 states limit the ability of NPs to perform at least one practice element independently and require they have a career-long regulated collaboration with another healthcare provider. 

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