If nurses want a larger role in health care policy, they need to increase their numbers on boards and commissions.
Louise Kaplan, associate professor at the WSU College of Nursing in Vancouver, recently made that case in her regular column in The Nurse Practitioner journal using the example of her colleague Tracy Klein, an assistant professor in the college.
“Currently, Dr. Klein is the only nurse practitioner known to chair a state’s drug use review/pharmacy and therapeutics committee,” Kaplan wrote. Such state “P&T” committees evaluate medicines for Medicaid’s preferred drug lists, taking into account the drugs’ effectiveness and safety.
Klein was elected chair of the Oregon Drug Use Review/Pharmacy & Therapeutics Committee in January 2019, after serving on various committees advising the state’s Medicaid program since 2002.
“Tracy’s committee does a great deal of work on evidence-based access to medication,” Kaplan says of her decision to write the column. “Having her in that position of influence is important.”
Kaplan notes in her column that Oregon law calls for only physician and pharmacist representation on its P&T committee, plus “two other people who are not physicians or pharmacists.” Yet nurse practitioners have full practice authority in Oregon, including prescribing medications and controlled substances.
Oregon’s P&T committee also is underrepresented for primary care and family practice providers, Kaplan says. Klein and a fellow committee member, a primary care physician, have collaborated to ensure family practice providers have access to a wide range of medications for Medicaid patients. They’ve also advocated for policies to minimize having to send a patient to a specialist to receive medication unless it’s necessary for safe use.
Kaplan urges nurse practitioners to get involved in P&T processes, whether by gaining a board seat, attending meetings, or even commenting via email.
“Boards are instrumental in formulating policy, be it organizational or governmental policy,” she says. “There’s a lack of nurse leaders in positions of influence.”
Klein, who’s also a regional director for the American Association of Nurse Practitioners, says, “Serving on an interdisciplinary committee such as the P&T has been both personally and professionally beneficial in my own teaching and practice. Prescribing is an area that is ripe for both error and undue influence from the pharmaceutical industry. My work with the P&T has made me a safer prescriber and better able to teach my own students how to incorporate evidence into their practice.”