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Gov. Stitt vetoes bill giving some nurses more authority to prescribe medication

Story by Jordan Gerard, The Oklahoman

March 29, 2024

Gov. Kevin Stitt has vetoed a bill passed by the Oklahoma Legislature that would have given advanced practice registered nurses full practice and prescriptive authority without physician supervision.  

Senate Bill 458 would have enabled qualified APRNs to apply for a license that would allow them to prescribe Schedule III through V drugs without physician oversight. The Schedule IV drugs on the list included medications for anxiety and depression like Valium, Klonopin, Xanax and clonazepam. Schedule III drugs would be codeine products and testosterone.

Stitt wrote in his veto message Friday he’s aware of the state’s health care access and workforce challenges, especially in rural communities, but said he didn’t believe APRNs should be able to prescribe those drugs without physician supervision.  

He encouraged the Legislature to explore other ways to attract frontline health care workers to rural communities across the state, such as a tax credit for qualifying practitioners in rural areas. 

As of January 2024, there were 1,706 physician assistants, 2,683 nurse practitioners and 5,454 professionally active primary care physicians in Oklahoma, according to the Kaiser Family Foundation, a health policy research group.

Dr. Jeanette Kelley, an internal medicine physician from Oklahoma City, supported Stitt's veto, saying approval would have discouraged physicians from coming to Oklahoma.  

“Who will want to go into primary care when a ‘short cut’ with little education can be taken?” she said. 

Sen. Brenda Stanley, R-Midwest City, authored the bill, which was carried over from introduction in 2023. She said rural Oklahoma is desperate for health care.  

“I’ve heard time and time again from members on this floor how they’ve used a nurse practitioner or a PA in lieu of a physician because they can take more time with that patient and prescribe the same thing,” she said in supporting the bill. “To me, this is a win for Oklahoma providing that great rural health care that we need.”

In this year's Senate debate, opinions differed. 

Sen. Darrell Weaver, R-Moore, said mid-level professionals were critical to Oklahoma’s medical community, adding that physicians’ assistants and nurse practitioners were worth their weight in gold. However, he said he was concerned about the difference in education levels between physicians and advanced practice registered nurses and oversight authority.  

“Just because it’s not a controlled, dangerous substance doesn’t mean you don’t need to know what that does. This body cannot do through legislation what has been done through education," Weaver said.

Sen. Jessica Garvin, R-Duncan, said she supports mid-level providers, but there was too much vague language in the bill. She wanted the bill to go to a conference committee for revision.  

Sen. Julie Daniels, R-Bartlesville, supported the bill, saying her primary care physician left her area two years ago and since then, it’s been hard to find another.  

“I’m thankful we have APRNs right now in Bartlesville. I need someone I can rely on and spend time with me,” she said. “In rural Oklahoma, we need all facets of health care, and this is one of them.”

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