WILMINGTON, N.C. -- As the school year gets underway, some school nurses are facing hurdles addressing students' health-care needs.

Diane Parker, lecturer at University of North Carolina-Wilmington, family nurse practitioner at Coastal Horizons, and school-based nurse in Wilmington, said school districts are already struggling with teacher shortages, and the state's Advanced Practice Registered Nurse (APRN) supervision requirements contribute to a chaotic situation.

Parker recounted she had to scramble to reinstate her previous supervising physician, at her own cost, after her new supervising physician had to delay their contract due to COVID-19 illness.

"If I didn't have that person to go back to, like, if she wasn't able to take me back, then I would not be able to practice in a school-based setting until my new collaborating physician was well enough to assume those responsibilities," Parker explained.

In 2019, 17% to 19% of students statewide received health care related to a chronic condition, like asthma or diabetes, according to the state Division of Public Health.

Under current state law, APRNs must work under doctor supervision, have a collaborative practice agreement, and meet once every six months with their supervising physician.

Parker added due to statewide nursing shortages, most school nurses work at multiple schools or split their time between a school and hospital or private practice. She lamented it means teachers and school staff, who have no medical training, are left to deal with kids' health emergencies or chronic conditions.

"And our center serves over 2,000 students and faculty," Parker observed. "And so, again, I would not be able to do my job, I would not be able to see patients or staff, without a collaborating physician."

While the American Medical Association and other physician groups argue collaborations are needed for patient safety, Parker argued supervision requirements are not necessary.

"It is nice to know that I have a collaborating physician in the community that I can reach out to if needed," Parker acknowledged. "But in all the time that I've had one, it's very rare that I've needed to do that."

North Carolina is one of the most restrictive states in the country for APRNs, according to a report by the National Academy of Medicine. The SAVE Act, introduced in North Carolina this year, would remove supervision requirements statewide.

Health disparities in Texas are not only making some people sick, but affecting the state's economy.

A new study shows Texas is losing $7 billion a year because it does not adequately address quality-of-life issues and the health care needs of its lower-income residents.

The research was sponsored by the Episcopal Health Foundation, Methodist Healthcare Ministries of South Texas, and St. David's Foundation.

Brian Sasser, chief communications officer for the Episcopal Health Foundation, said health care includes more than doctors' visits and medication.

"Everything from increasing access to affordable health insurance to investing in under-resourced neighborhoods to give them more options, whether that's exercise options or food options," Sasser outlined. "Look at policy changes that expand health insurance coverage for new moms."

The report breaks down the economic costs of preventable health differences for every Texas county. It found Bexar, Dallas, Harris, Tarrant and Travis counties are losing the most money annually because of health disparities.

The amount of the economic impact depends on the racial and ethnic makeup of the county and the size of its working-age population. Sasser added the report shows Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and higher rates of diabetes and obesity.

"What can we do to work to make sure that the rate of diabetes isn't dramatically different between white households and Black households?" Sasser asked. "That we can make sure the food insecurity isn't dramatically different between someone who makes over $100,000 and someone who makes less than $30,000?"

The Texas Legislature has passed laws to address some of the disparities, including House Bill 12. It extends Medicaid health coverage for 12 months for new mothers, and pays for maternal health services for community health workers and doulas.

There is light at the end of the tunnel for Tennesseans struggling with opioid addiction, as a bill has been passed to increase access to treatment for opioid use disorder at Community Health Centers.

More than 3,800 lives were lost to overdose in the state in 2021, according to the Tennessee Department of Health.

Emily Waitt, policy and advocacy manager for the Tennessee Primary Care Association, said the original bill limited the number of patients nurse practitioners and physician assistants could treat with buprenorphine. The update removes the limitations, allowing more Tennesseans to access medication assisted treatment in their communities.

"It allows NPs and PAs to prescribe to 100 patients at a time, versus 50," Waitt explained. "Basically doubling the number of patients that they can prescribe to."

Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay. About 7.7% of Tennesseans do not have health insurance.

Libby Thurman, CEO of the Tennessee Primary Care Association, said bringing the treatment to rural health centers expands access to a crucial service for patients who otherwise could not afford it. She noted it is important because people in remote areas often face challenges finding specialists and treatment facilities.

"We really wanted to work on this issue, because we know our Community Health Centers are where patients go for care," Thurman emphasized. "We really believe in an integrated model. So we want to treat the whole person, including if they are struggling with an addiction issue or a substance abuse disorder issue."

Health Centers offer behavioral health care, including counseling, along with treatment. The clinics also focus on creating a supportive network to help patients with family resources, job assistance and community connections.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"