Missouri’s general assembly dropped the ball on a lot of policy priorities during the 2024 legislative session, but one of the most impactful may be the failure to address the state’s healthcare access issues. One unfortunate byproduct of inaction is that our state, which is already suffering from a shortage of nurses, will have to withstand another year of losing nurses to surrounding states as they leave for better opportunities.
It’s no secret that many Missourians struggle with healthcare access. For large parts of the state, there simply aren’t enough doctors. In those areas, nurses have often been tasked with filling the void. Advanced practice registered nurses (ARPNs), who are trained to treat many of the things people would normally visit the doctor for, are particularly well suited to help address doctor shortages. Unfortunately, the law that governs what nurses licensed in Missouri can do is unnecessarily restrictive.
My colleagues have written about the need to expand nurse’s scope of practice for years. In Missouri, APRNs are required to enter what are called collaborative practice agreements with doctors before they can treat any patients. These agreements can come with a variety of stipulations including the number of patients the APRN can see, how frequently they have to meet with the doctor and have their charts reviewed, and even mandating that they cannot be more than a certain number of miles away from the doctor to practice independently. In 2023, Missouri’s legislature scaled back some of the collaborative practice agreement requirements, including the ability to waive the geographic proximity requirements in some circumstances, but there’s still a long way to go to make Missouri’s licensing laws for nurses competitive with other states.
Most states don’t have any geographic proximity requirements, and it’s easy to see why. Imagine you’re a nurse who is treating patients outside of Cape Girardeau in southeast Missouri. There likely aren’t many doctors in the region. There are significantly more doctors around St. Louis, but they’d be too far away to comply with Missouri’s geographic proximity requirement.
In 2024, it’s hard to imagine how geographic proximity rules are still necessary. Maybe they made sense in 1970, but with today’s advancements in technology, it’s hard to see them as much more than an unnecessary hurdle that limits the number of healthcare providers across Missouri.
It’s time for Missouri’s elected officials to start taking the state’s healthcare access problems seriously because they aren’t going to fix themselves. Until action is taken, no one should be surprised when more and more nurses leave the state, further exacerbating Missouri’s shortage of healthcare providers.
