Miller explains that in Minnesota, APRNs must practice under collaborative agreements with individual physicians which have to be specific to the practice setting they work in. The agreements are specific to each practice site, outline which drugs they may prescribe, and must be kept on file at each worksite.
"It does nothing to ensure safety," she says of the agreements. They're also cumbersome: APRNs need different collaborative agreements for every, physical venue where they practice. This is not only inconvenient for APRNs, but also costly and time-consuming when it comes to credentialing.
"There's a price that gets added on when you have to monitor" all of these disparate pieces of paper, Miller says.
Plus, such a requirement can leave practices in a lurch. For example, if a physician leaves a practice, nurses "could be able to prescribe one day and not the next," Miller says. The situation is especially bad for APRNs in areas like rural Minnesota, which has a dearth of mental health physicians.
"They can't practice because they can't find a psychiatrist to sign their collaborative agreement," Miller says.
She and her colleagues are working with their graduate- and doctorate-level students to engage them in the legislative process, encouraging them to attend town hall meetings and community gatherings that are focused on health. They also ask students to participate in letter-writing campaigns to legislators and the governor and to join Minnesota APRN Coalition meetings by phone.