AUSTIN, Texas – Algunas organizaciones de Texas dicen que las necesidades de atención a la salud en las comunidades rurales sería mejor si al personal de enfermería se le permitiera tratar a los pacientes aplicando todo el conocimiento adquirido durante su capacitación.

En Texas hay más de 300 comunidades con un servicio médico insuficiente, y algunos grupos afirman que pudieran ser mejor atendidas con un cambio en las normas.

El personal Registrado de Enfermería con Práctica Avanzada (“Advanced Practice Registered Nurses”), conocido como APRN por sus siglas en inglés, tiene total capacitación para tratar y diagnosticar enfermedades agudas y crónicas, y aplicar los cuidados primarios completos. Pero las normas de Texas les impiden ofrecer estos servicios al máximo de su capacidad y entrenamiento profesionales.

Elizabeth Ellis es una profesional de la enfermería con nivel doctoral (DNP), Enfermera Registrada (RN), Practicante de Medicina Familiar (FNP-BC) y propietaria de una clínica en Bedias. Explica que hay una norma de supervisión que limita el campo de práctica de los APRN porque les exige tener un contrato con un médico colaborador.

“Texas es un estado tan grande como sus necesidades de atención a la salud y sus necesidades rurales de salud. Debemos ir con el futuro y ofrecer una práctica independiente a nuestro personal capacitado y con experiencia en enfermería.”

Texas ocupa el lugar número 46 entre los estados en cuanto a cantidad de médicos que practican en áreas rurales. La AARP, la Asociación de Negocios y la Fundación de Política Pública de Texas están entre los grupos que apoyan una mayor cobertura de su práctica.

Investigaciones del Diario de Practicantes de Enfermería (Journal of Nurse Practitioners) muestran que para los pacientes atendidos por practicantes de enfermería, el resultado en términos de salud es el mismo o mejor que por un médico.

“Estamos teniendo que pagarles y en mi caso desviar fondos de mi clínica que podrían usarse para tener servicios o equipo adicionales, para poder pagarle a un médico que sea mi proveedor colaborador (Collaborating Provider).”

Algunas organizaciones de médicos argumentan que los doctores tienen capacitación y experiencia más amplias en el cuidado de pacientes, y dicen que se necesitan reglas para garantizar la seguridad. Pero Ellis responde que cambiar las normas no acabaría con la colaboración entre profesionales médicos.

“Todos tenemos nuestras propias limitaciones y visión, así que si eres un buen practicante sabes cuáles son tus limitaciones y siempre acudirás a tu colega para garantizar el tratamiento apropiado para tu paciente cuando lo necesites.”

Más de 20 estados más permiten a los practicantes de enfermería trabajar en toda su área de capacitación sin un contrato de supervisión, y el Departamento de Asuntos de Veteranos (Deparament of Veterans Affairs) también les dio autoridad para una práctica ampliada.


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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added that once the bill is passed, the state can build off it by allowing people to earn more than 40 hours of paid sick time. Woods Weber said the isolation requirements during the pandemic forced anyone who got COVID-19 to use their allotted sick time all at once for isolation.


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