Nurses Frustrated By Limits On Authority Idaho Considers Expanding Level Of Care Nurses Can Offer

Without a boat, Judy A. Metelko can’t give her patients adequate care.

Idaho law doesn’t allow Metelko, a Lewiston clinical nurse who specializes in mental health, to prescribe drugs or diagnose patients.

But when Metelko crosses the Snake River into Washington, she can diagnose ailments such as depression and prescribe drugs like Prozac.

“It makes it very difficult for patients,” Metelko said. “It costs more if I have to have a psychiatrist come in and do an assessment.

“I joke about being a boat therapist,” Metelko added with a hint of frustration. “Then I could give out medication in the middle of the river.”

Idaho lawmakers are debating a bill that would recognize Metelko and other advanced practice nurses. That means without any more education, she could perform the same tasks in Idaho that she does in Washington.

The measure also would recognize certified nurse-midwives, who specialize in pre-to-post birth care.

Currently, Idaho law only acknowledges nurse practitioners and registered nurse anesthetists.

These changes would increase the availability of affordable health care in Idaho, supporters say.

Sandpoint doctor Bruce Honsinger said these nursing professionals help ensure quality care throughout Idaho, but especially in low-income areas.

“Advanced practice nurses let us provide services to poor, rural communities,” Honsinger said. “And let me tell you, we give them Cadillac care.”

The obstetrician-gynecologist works with four advanced practice nurses at his clinic, Sandpoint Women’s Health.

“It’s a very common means of practice, something we’ve been doing for years,” Honsinger said.

However, the state Board of Medicine member hasn’t always supported the legislation.

When the state Board of Nursing first introduced the measure, Honsinger and the medicine board rallied against a provision that reduced the amount of supervision doctors had over nurses’ work - a move many doctors including Honsinger said was dangerous.

Heidi Crouch, a nurse practitioner in Potlatch and Elk River, said physicians are just trying to protect their market.

Since July 1996, Crouch has operated a solo practice in Potlatch. She collaborates with two supervising physicians who review her charts, discuss cases and make themselves available day and night to answer questions.

“We’re not doctors, we’re not trying to be doctors,” Crouch said about advanced practice nurses.

After many battles and defeats, the nurses hammered out a compromise with the Board of Medicine. The doctor supervision was left in, but the bill makes it easier for the nurses to get licenses.

A House Health and Welfare subcommittee labored for days to reach the deal. Cheers erupted from lawmakers, nurses and doctors when the new compromise bill passed the full committee.

Last week, the bill flew through the House without opposition, 66-0.

“It was a difficult compromise to reach,” Honsinger said. “I’m happy to see it.”

Besides giving advanced practice nurses limited prescription authority and adding two new categories of nurses, the measure would give the nursing profession due recognition. The measure would remove the oversight of advanced practice nurses from the state Board of Medicine’s hands. Currently the boards of nursing and medicine share governing responsibility of the state’s advanced practice nurses.

“The nursing profession has gained a great deal in terms of what we wanted to gain,” said Sandy Evans, the nursing board’s executive director.

The Senate will debate the bill next.

If the law doesn’t change, Metelko said she may have to move her practice out of state.

“I’ve gotten so frustrated,” she said. “It’s an important bill for me to remain in Idaho.”

, DataTimes ILLUSTRATION: Color Photo

The following fields overflowed: BYLINE = Erica Curless Staff writer Staff writer Julie Titone contributed to this report.