Expand scope of care for nurse practitioners

A nurse with her young patient, and the patient's father. (Photo: Monkey Business Images, via Shutterstock)

Kern County residents are afflicted by the highest rate of diabetes in the state, according to recent data from the California Department of Public Health.[1]  As a nurse practitioner at the Kern Medical and a certified diabetes educator, I see the faces of the people behind that startling statistic every day.  They are our parents, brothers and sisters, sons and daughters, and advocating for their health is my passion.

So when I see our Kern county residents – a population that is more than half Latino and where more than one in five live in poverty – disadvantaged by an outdated state law, I’m obligated to speak up. I am calling on state legislators to support SB 323 by Senator Ed Hernandez to remove an outdated law that prevents nurse practitioners like me from providing the full scope of care to meet my patients’ language and cultural needs.  Passing this bill will save lives.

The federal government has designated Kern county as a physician shortage area – meaning we have too few doctors to serve our population.

In my 24 years at Kern Medical, much has changed. Technical advances and understanding of how cultural and socioeconomic factors affect health have changed our approach to health care.  In 2010 Kern County issued a “Call to Action” to fight chronic disease and obesity, calling for screening and education to prevent diabetes and related diseases.  Providers who are knowledgeable about the “cultures, traditions, and languages” of our residents are a central part of that plan[2] – but state law stands in the way of its success.

California is one of just 12 states that still excludes qualified nurse practitioners from taking a leading role in helping patients prevent and manage chronic disease like obesity, diabetes and hypertension.  I believe this outdated model has deadly consequences for people in our community, where our specialized care for diabetes suffers for lack of qualified health care providers.

A 54 year-old woman, a lifelong farmworker, came into my hospital with diabetes so advanced her toe had to be amputated.  Her prescribed medication had not kept her blood sugar under control and she didn’t have the information she needed to use insulin properly to manage her condition.  Without access to a primary care practitioner whom she understood and who understood her, she relied on family members’ advice rather than medical information.  Her next trip to the hospital came too late — after she had developed kidney failure.  I believe our medical system failed this hard-working mother – not in the hospital, but by denying her the services she needed to avoid a trip to the hospital in the first place.

If this member of our community had access to adequate primary care that fully addressed her as a person and helped her understand her healthcare, if someone had spent the time and understood the cultural and language barriers she faced, she might be alive today.   Nurse practitioners are far more representative of our diverse populations than our physician workforce, and are therefore uniquely positioned to understand the social and emotional factors affecting health.  Empowering nurse practitioners to utilize the full scope of our training would break down health care barriers faced by poor, rural, and Latino communities.

The federal government has designated Kern county as a physician shortage area – meaning we have too few doctors to serve our population.  SB 323 would help nurse practitioners meet this shortfall, and alleviate long waits to see a healthcare provider.  The bill would enable doctors to focus on providing treatments that only MDs are trained to do, instead of duplicating the work of highly trained nurses. What’s more, when our nurse practitioners can act independently to help patients prevent and manage disease – within our training and qualifications – more effectively partner with patients to overcome cultural and language barriers to preventive care and save lives in the process.

Ed’s Note: Carmen Morales-Board is a nurse practitioner and Certified Diabetes Educator at Kern Medical Center.

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