As the Sunflower State considers legislation, House Bill 2279, to address primary care provider shortages, a new statewide survey of Kansas voters shows broad bipartisan support to make it easier for patients to choose nurse practitioners (NPs) as their primary care providers. The poll, conducted by the Mellman Group February 16-21, found nearly three-fourths of Kansans back legislation that would enable patients to choose NPs.
In fact, support extends across key demographics for the state to end regulations requiring NPs to hold a government-mandated contract with a physician to provide patient care and services. Those demographics include gender, age, party identification and regions of the state. Further, most voters said they would be more likely to vote for a legislator who agreed to remove these restrictions.
If enacted into law, House Bill 2279 would make Kansas the 25th state to give patients full and direct access to NP-delivered care through Full Practice Authority (FPA), a legislative solution embraced by the National Academy of Medicine, National Governors Association, American Enterprise Institute and many others.
“Despite the state’s years of investment in physician residency and loan repayment programs, Kansans continue to face serious primary care and mental health access challenges. The data shows that Kansas patients are seeking NP-delivered care, and they want the legislature to modernize policies to allow them to choose NPs,” said April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners® (AANP). “It’s time for Kansas to retire these barriers that limit patient choice and access to NPs. Kansans want to implement tried-and-tested policies already embraced by nearly half the nation.”
According to the U.S. Health Resources and Services Administration, as of Dec. 31, 2021, nearly 781,000 Kansans live in a federally designated primary care health professional shortage area where only approximately 52% of the need for primary care services is met. Even more alarming, mental health professional shortages impact more than 1.3 million Kansans, with just 32.74% of the need being met.
“This is a no-cost, no-delay solution that immediately cuts red tape in our state’s health system. We know 24 other states with this model in place are, frankly, more competitive: They have better access to care and more choices available for their patients,” said Christie Kriegshauser, director of government affairs for the Kansas Chamber of Commerce. “We urge state legislators to stand with Kansas voters, who have made their position clear. Kansas needs to be competing at the same level to start seeing some of these benefits. The time is now to pass this important legislation and improve the delivery of high-quality health care across our state.”
This week, the state Senate passed the bill by a vote of 30-7. It now moves over to the state House for approval.
Registered nurse Pascaline Muhindura has spent the past eight months treating COVID patients at Research Medical Center in Kansas City, Missouri.
But when she returns home to her small town of Spring Hill, Kansas, she’s often stunned by what she sees, like on a recent stop for carryout food.
“No one in the entire restaurant was wearing a mask,” Muhindura said. “And there’s no social distancing. I had to get out, because I almost had a panic attack. I was like, ‘What is going on with people? Why are we still doing this?’”
Many rural communities across the U.S. have resisted masks and calls for social distancing during the coronavirus pandemic, but now rural counties are experiencing record-high infection and death rates.
Critically ill rural patients are often sent to city hospitals for high-level treatment and, as their numbers grow, some urban hospitals are buckling under the added strain.
Kansas City has a mask mandate, but in many smaller communities nearby, masks aren’t required — or masking orders are routinely ignored. In the past few months, rural counties in both Kansas and Missouri have seen some of the highest rates of COVID-19 in the country.
At the same time, according to an analysis by KHN, about 3 in 4 counties in Kansas and Missouri don’t have a single intensive care unit bed, so when people from these places get critically ill, they’re sent to city hospitals.
A recent patient count at St. Luke’s Health System in Kansas City showed a quarter of COVID patients had come from outside the metro area.
Two-thirds of the patients coming from rural areas need intensive care and stay in the hospital for an average of two weeks, said Dr. Marc Larsen, who leads COVID-19 treatment at St. Luke’s.
“Not only are we seeing an uptick in those patients in our hospital from the rural community, they are sicker when we get them because [doctors in smaller communities] are able to handle the less sick patients,” said Larsen. “We get the sickest of the sick.”
Dr. Rex Archer, head of Kansas City’s health department, warns that capacity at the city’s 33 hospitals is being put at risk by the influx of rural patients.
“We’ve had this huge swing that’s occurred because they’re not wearing masks, and yes, that’s putting pressure on our hospitals, which is unfair to our residents that might be denied an ICU bed,” Archer said.
A study newly released by the Centers for Disease Control and Prevention showed that Kansas counties that mandated masks in early July saw decreases in new COVID cases, while counties without mask mandates recorded increases.
Hospital leaders have continued to plead with Missouri Republican Gov. Mike Parson, and with Kansas’ conservative legislature, to implement stringent, statewide mask requirements but without success.
Parson won the Missouri gubernatorial election on Nov. 3 by nearly 17 percentage points. Two days later at a COVID briefing, he accused critics of “making the mask a political issue.” He said county leaders should decide whether to close businesses or mandate masks.
“We’re going to encourage them to take some sort of action,” Parson said Thursday. “The holidays are coming and I, as governor of the state of Missouri, am not going to mandate who goes in your front door.”
In an email, Dave Dillon, a spokesperson for the Missouri Hospital Association, agreed that rural patients might be contributing to hospital crowding in cities but argued that the strain on hospitals is a statewide problem.
The reasons for the rural COVID crisis involve far more than the refusal to mandate or wear masks, according to health care experts.
Both Kansas and Missouri have seen rural hospitals close year after year, and public health spending in both states, as in many largely rural states, is far below national averages.
Rural populations also tend to be older and to suffer from higher rates of chronic health conditions, including heart disease, obesity and diabetes. Those conditions can make them more susceptible to severe illness when they contract COVID-19.
Rural areas have been grappling with health problems for a long time, but the coronavirus has been a sort of tipping point, and those rural health issues are now spilling over into cities, explained Shannon Monnat, a rural health researcher at Syracuse University.
“It’s not just the rural health care infrastructure that becomes overwhelmed when there aren’t enough hospital beds, it’s also the surrounding neighborhoods, the suburbs, the urban hospital infrastructure starts to become overwhelmed as well,” Monnat said.
Unlike many parts of the U.S., where COVID trend lines have risen and fallen over the course of the year, Kansas, Missouri and several other Midwestern states never significantly bent their statewide curve.
Individual cities, such as Kansas City and St. Louis, have managed to slow cases, but the continual emergence of rural hot spots across Missouri has driven a slow and steady increase in overall new case numbers — and put an unrelenting strain on the states’ hospital systems.
The months of slow but continuous growth in cases created a high baseline of cases as autumn began, which then set the stage for the sudden escalation of numbers in the recent surge.
“It’s sort of the nature of epidemics that things often look like they’re relatively under control, and then very quickly ramp up to seem that they are out of hand,” said Justin Lessler, an epidemiologist at Johns Hopkins Bloomberg School of Public Health.
Now, a recent local case spike in the Kansas City metro area is adding to the statewide surge in Missouri, with an average of 190 COVID patients per day being admitted to the metro region’s hospitals. The number of people hospitalized throughout Missouri increased by more than 50% in the past two weeks.
Some Kansas City hospitals have had to divert patients for periods of time, and some are now delaying elective procedures, according to the University of Kansas Health system’s chief medical officer, Dr. Steven Stites.
But bed space isn’t the only hospital resource that’s running out. Half of the hospitals in the Kansas City area are now reporting “critical” staffing shortages. Pascaline Muhindura, the nurse who works in Kansas City, said that hospital workers are struggling with anxiety and depression.
“The hospitals are not fine, because people taking care of patients are on the brink,” Muhindura said. “We are tired.”
Published courtesy of Kaiser Health News. This story is from a reporting partnership that includes KCUR, NPR, and KHN. KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Nurse of the Week Julie Wedan oversees the management of her brainchild, a respite care wing at Wichita’s Union Rescue Mission for homeless men, and the results have been impressive. Doug Nolte, CEO of Union Rescue Mission, said, “Julie saw a need for a safe, clean environment for men discharged from a care facility to heal. It caused her to research, advocate and solicit funds to get a respite wing opened.” The 18-bed wing provides rehabilitation care for homeless men recovering from illness, accidents, or surgery. Men in the respite wing also receive help with medication, insurance, and establishing primary care physicians.
For Wedan, who has worked full-time caring for the homeless community in Wichita since 1997, the respite wing is her “dream.” In an interview with the Wichita Business Journal, she said, “This is a dream that started with a walk-in medical clinic every Friday.” For many of the men, their time in the wing is the start of a journey toward a stable living situation. After they recover, Union Rescue helps them find “assisted living, sometimes an apartment, whatever is appropriate for the individual,” Wedan says. “We also help them set up house with a bed, furniture and necessities of life.” Mission CEO Nolte noted, “Many of our guests coming to recover end up asking how they can continue in our programs to end their homelessness.”
Wedan is yet another nurse who became drawn to the profession after experience as a patient. Her time in the hospital during a complicated childbirth inspired her to enter nursing school. Three years after her 1994 graduation, she became a nurse at Union Rescue, and has been fully committed to serving the homeless over the past 30 years: “I love my job. I see men helped every day, all day throughout the Mission. We share God’s love. We want the men to know that they are loved and that someone cares about them…”
For more details on Julie Wedan and the Union Rescue Mission for the homeless, see this article in the Wichita Business Journal.
The University of Kansas Health System recently announced that Lindsay Norris, RN, has received the American Nurses Credentialing Center (ANCC) National Magnet Nurse of the Year Award. The award is in the category of Structural Empowerment and recognizes Norris’s contributions to internal education by improving professional nursing certification at the University of Kansas Hospital.
A personal battle with Stage 3 colorectal cancer in 2016 inspired Norris to better educate and equip her teams, and led to her writing an open letter to cancer patients that received national attention. Norris tells PRNewswire.com:
“The relationship between the nurse and patient is so important because we serve as a lifeline. Patients are just trying to process all the information related to their cancer and we get the opportunity to be a translator. Being a Magnet nurse at a Magnet designated hospital gives me that added confidence boost to empower the people I work with to help patients better navigate their cancer treatment.”
The ANCC National Magnet Nurse of the Year award recognizes the outstanding contributions of clinical nurses across the country for innovation, consultation, leadership, and professional risk-taking. The awards are presented in five Magnet Model areas: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, and Improvements; and Empirical Outcomes.
To learn more about University of Kansas Hospital oncology nurse Lindsay Norris and her ANCC National Magnet Nurse of the Year Award, visit here.