RALEIGH, N.C. -- Some doctors in North Carolina are voicing their support for legislation to cut red tape for Advanced Practice Registered Nurses (APRNs).

More than 20 states and the District of Columbia already grant licensed APRNs full practice authority, meaning they don't need to pay a doctor to supervise them.

The SAVE Act, introduced in North Carolina this year, would remove supervision requirements.

Dr. Elizabeth Golding, medical director for palliative care services at Cone Health, said there wouldn't be enough palliative medical care available in the state without APRNs, and believes supervision requirements, which often cost APRNs thousands of dollars, are a hindrance to patients' getting high-quality care.

"They really do nothing to improve the quality of care, and in my opinion are really, in truth, unnecessary and are just costly administrative hoops," Golding argued.

While individual physicians are speaking out, the North Carolina Medical Society has repeatedly opposed allowing APRNs to practice independently, arguing eliminating doctor supervision would increase safety risks for patients.

Dr. William Long, a primary care and geriatric physician in Charlotte, explained supervision requirements do not require doctors and APRNs work closely together. Long added some supervising physicians live hours away, or even in another state, from their collaborating APRN.

"I just don't think that's the spirit of what the law is," Long contended. "I think the law should be modified so that after a certain period of time, and pick your number, two years, three years, whatever, those individuals are very competent in the scope of practice that they're in."

Dr. Jessica Cannon, a retired OB/GYN physician in Wilmington, pointed out full-practice APRNs could help more North Carolina women have healthy pregnancies and healthy babies, especially in rural counties.

"We know that in states where certified nurse midwives have independent practices, that the outcomes are known to be just as safe as traditional OB/GYN outcomes, and in many cases, they have superior outcomes," Cannon observed.

Research shows APRN midwives lower risks for women and babies. Compared with obstetricians, midwifery care has led to much lower intervention rates and reduced the odds of Cesarean delivery by 30% for women having their first baby.

As winter looms in Missouri, health officials are expressing concern over the potential for three viruses to impact facilities.

This season has already seen an early spike in flu cases - and widespread impact among children from Respiratory Syncytial Virus, or RSV.

The potential for another COVID spike to add to this situation has some medical experts worried about a so-called 'tripledemic,' straining the health-care system.

Recent memory features the COVID surge in early 2020 filling up hospitals, but Dave Dillon - spokesperson for the Missouri Hospital Association - said while there are some similarities to that time there is one important difference.

"Unlike where we were in the beginning portion of 2020 where hospitals didn't have tools, but they had a lot of staff and a lot of space, right now we are limited on staff," said Dillon. "A lot of individuals have left the profession, especially front-line care givers like nurses."

Data analysis of the nursing workforce shows that the total supply of Registered Nurses in the U.S. decreased by 100,000 in 2021, the largest drop ever recorded.

Dillon said this flu season is showing early intensity, being both very contagious and requiring a much higher degree of hospitalization than normally seen at this stage of the season.

He said that while RSV is impacting capacity at children's hospitals, it's not anticipated to impact adult bed availability.

"Unless the influence of the other viruses creates a significant shortage of hospital bed availability," said Dillon, "RSV is not likely to have a significant negative influence upon adult bed capacity for seniors who are more likely to be hit hard by RSV. "

Experts advocate keeping up to date on vaccinations for COVID and flu.

Nebraska is one of a dozen states experiencing "very high" levels of influenza, and the highest percentage of cases has been in children and young adults.

Children under 17 account for more than half the Nebraska flu cases so far, with the highest numbers in the five- to 17-year-old age group, and second-highest in children birth to four years of age.

Molly Herman, epidemiology coordinator for the Northeast Nebraska Public Health Department in Wayne, where they have among the highest percentages in the state, said the strain they are seeing the most is H3N2.

"That is usually a strain that causes more severe illness in people, more hospitalizations and more deaths," Herman pointed out. "It's really important to get vaccinated, because any flu vaccine is going to give you a level of protection that's going to help keep you from getting super sick."

The Centers for Disease Control and Prevention recommends flu shots for anyone over six months of age, and parents with questions should check with their child's doctor. And for preventing illnesses of all kinds, it's important to wash your hands regularly, cover coughs and sneezes and be willing to stay home when you're not feeling well.

There have been two flu-related deaths in Nebraska so far, and four reported outbreaks in long-term care facilities.

Douglas County has the highest percentage of flu cases in the state, and the highest number of flu-related hospitalizations by this point in over a decade. In November, the county reported 2,300 cases, compared to 26 last November.

Herman noted RSV infection is also high in her region, although statewide, RSV cases peaked in early November and have slowly declined since then. She added COVID numbers have varied, and the state's wastewater monitoring has been very helpful in predicting what they might see.

"And what we've found is that whenever the concentration of virus goes up in wastewater, about 10 to 14 days later, we will see a rise in cases locally," Herman explained. "We saw a huge spike in wastewater about November first, and then, sure enough, 10 to 14 days later is when we started our increase in cases."

The state's mid-November wastewater surveillance revealed COVID to be "high to very high" in 12 of 14 sites monitored. With flu, RSV and COVID circulating, health experts say there's a risk of co-infection, with two or even three viruses at the same time.

Results of a new survey show many young people are worried about losing access to birth control.

The survey, by the nonprofit Power to Decide, found about seven in 10 young adults think the U.S. Supreme Court's decision to overturn Roe v. Wade, which protected the right to an abortion, will also limit access to birth control.

Federal lawmakers have stepped in to try to codify rights to birth control, with the Right to Contraception Act, which passed in the House but is stalled in the Senate.

Tara Mancini, director of public policy at Power to Decide, noted there are actions which could be taken at the state level.

"We've seen some states work to amend constitutions to give folks the right to abortion," Mancini observed. "Michigan was even more broad, recognizing the right to, not just abortion, but sexual and reproductive health care."

In 2019, New York approved the Comprehensive Contraception Act, which provides insurance coverage for Food and Drug Administration-approved contraceptive drugs, devices and products. Mancini added providing more funding to Title 10 programs could help, so clinics and communities can offer family planning and STI testing services.

She pointed out it would also reduce the number of "contraception deserts," including in parts of New York.

Power to Decide is hoping more people bring issues about abortion and contraception to light, so they won't seem rare. Mancini noted there is still a stigma associated with birth control, including the myth of one method being best for everyone. Her group works to ensure people have access to a wide range of birth control options.

"Every person is different, everybody is different, and so what works for me might not work for my neighbor," Mancini asserted. "That's why it's essential that folks have access to the full range of birth control methods, of which there are over 18 FDA-approved method categories."

She added another myth is birth control is easy to get. Despite myths and stigmas, Mancini feels hopeful for the future of birth control, since the survey found it is not a controversial topic overall, and is accepted across ethnicities and the political divide.