Years ago every town had one. They served as a meeting place for friends and neighbors. You could catch up on local news and wet your whistle at the same time.
This long-gone establishment was the general store. It carried candy, soda, cigarettes, gas, hardware and a few clothing items like gloves and hats. Some were even run by a “registered” pharmacist and carried medicine for what ailed you.
In the small northwestern Kansas community where I grew up, Albert Dreese owned and operated the general store. Mr. Dreese would take your shopping list, grab a brown paper bag and grope through dimly lighted aisles and the maze of store items carefully selecting and filling your order.
When Mr. Dreese returned he’d hand my mom the bag and me a sucker or balloon before bidding us good-bye and returning to his cronies and the pitch game at the small table in the center of the store.
Mr. Dreese never rang up your bill on a computer or cash register either. He figured everything in his head, wrote it down on a small note pad and made change out of the front pockets of his trousers.
While a card game was in progress, it was up to individual players to serve themselves a soda or beer and deposit the correct change on the counter top. No interruptions please – the game was all-important. Peanuts to munch on while playing cards were weighed out on a scale and poured into a small brown bag.
During the winter, no one stoked the pot-bellied stove except Mr. Dreese because a cherry red stove would melt all of his chocolate bars, or that’s what he told all the youngsters who visited his store. Why, he even ran old Mr. Reinhart out of the store one day for tampering with his stove.
Another source of entertainment in the general store was a one-armed bandit – yep, right in the little community of Seguin. Farmers around home didn’t need to travel to Las Vegas to gamble – they farmed for a living and dropped by the back room of Mr. Dreese’s store. The sheriff never knew about this one-armed bandit, or so I thought.
Every so often when I had a few coins burning a hole in my pockets, Davey Thummel and I would walk down to the store and plunk down a dime for a Coke and fill it with a nickel bag of Planters peanuts.
Albert Dreese isn’t around anymore. Neither is the store. His business and others like it couldn’t compete with the giant supermarkets and box stores offering lower prices and modern conveniences all under one roof.
No, Mr. Dreese’s store didn’t have air conditioning for those hot, northwestern Kansas summer days. It didn’t have air pudding (elevator) music, coupons or anything you could want, or didn’t need, to entice customers from Norton, Colby, Oakley and the rest of northwestern Kansas.
All Mr. Dreese had to offer was himself, a smile and dedicated service to his friends and neighbors who dropped by his small general store.
Yes, Albert Dreese is dead and a part of history died with him. We don’t have general stores anymore. His personal touch and sincere interest in his neighbors, friends and customers has been replaced by whirling blue lights, swarming shoppers and cars, screaming kids and aisles and miles of consumer items.
John Schlageck is a leading commentator on agriculture and rural Kansas. Born and raised on a diversified farm in northwestern Kansas, his writing reflects a lifetime of experience, knowledge and passion.
The Advanced Airlift Tactics Training Center (AATTC) is hosting its 32nd annual Tactics and Intelligence Symposium through Thursday.
More than 300 participants are anticipated to attend including U.S. military and foreign allied nations personnel. Dozens of commercial venders will also showcase equipment and tools related to tactics development.
This year’s theme is “Bringing It All Together”.
The symposium serves as a venue for tacticians to share information. Attendees will learn from subject matter experts and network with fellow mobility professionals. It also promotes interaction with vendors. Attendees can view innovative products and help shape the development of future combat systems.
The AATCC has seen an increase in attendees from other aircraft communities other than the C-130 Hercules and C-17 Globemaster III. Those communities include the C-5 Galaxy, C-26 Metroliner, KC-10 Extender, and KC-135 Stratotanker.
Unique to this year’s event will be an emphasis on information sharing with coalition partners to provide additional training and expand information sharing with these allied partners.
The AATTC is a tactics school comprised of 76 personnel from the U.S. Air Force, Air National Guard, and Air Force Reserve. The school trains some 900 students per year and more than a dozen allied nations have trained here.
The Missouri Air National Guard’s 139th Airlift Wing is comprised of approximately 1,100 citizen-Airmen from local communities throughout the region. The unit operates the C-130H Hercules cargo aircraft and has a duel mission both to the state of Missouri and the Federal government. Rosecrans Air National Guard Base is located at Rosecrans Memorial Airport, St. Joseph, Mo.
TOPEKA — Kansas’ growing doctor shortage could be addressed by allowing nurses with advanced skills to work more independently of physicians, say those advocating a change in state law that would allow that to happen.
Currently under Kansas law, advanced practice registered nurses (or APRNs) must work under a so-called “collaborative practice agreement” with a supervising doctor before providing health care services within the nurse’s certified level of training.
A proposal expected to soon be before legislators would free APRNs from that requirement and allow them to diagnose, treat, and prescribe medications for their patients without an agreement with a physician.
Rep. Peggy Mast, R-Emporia, speaks with Merilyn Douglass, a advanced practice registered nurse from Garden City and chairwoman of the Kansas APRN Task Force. Photo by Phil Cauthon, KHI.
Similar bills have been proposed in previous years at least as far back as 2009, but failed to advance. And the state’s leading doctor group already is signaling its opposition to this year’s proposal.
A bill could be introduced Wednesday in the Senate Ways and Means committee, according to members of the Kansas APRN Task Force, which is pushing the measure.
“Established practices are doing well,” said Merilyn Douglass, an advanced practice registered nurse from Garden City and chair of the Kansas APRN Task Force. “The biggest barrier that the signed physician agreement presents is in starting a practice. If we want to improve access to care for Kansans, we need more providers out there so that patients can call and get an appointment in a reasonable period of time. Patients deserve access to care, not to have to wait months to establish with a physician.”
She said she knew of at least one example in southwest Kansas where a nurse working for a soon-to-retire physician wanted to keep the clinic going but was having trouble finding a new supervising doctor to step in.
“Just like a lot of other states, we have a big population of Kansans who are going to need a primary care provider. There’s not enough physicians for all those new people, let alone an aging population that requires more visits and more complicated care,” Douglass said.
Other states
Across the U.S., there are three basic practice arrangements for nurses:
• Restricted: 12 states require direct supervision by a doctor in order to provide patient care;
• Collaborative practice: 21 states including Kansas require APRNs to have an agreement with a doctor, who oversees patient care to the degree the doctor deems necessary; or
• Unrestricted: 17 states and the District of Columbia have passed laws that allow APRNs to treat patients independently of physicians. Iowa and Colorado are among the unrestricted states.
As proposed in the bill draft, Kansas nurses would still have to undergo a “transition-to-practice” period under the supervision of a physician. That period would be 2,000 hours or about a year. That’s at least twice the length proposed in the plans put forth in previous years, said Mary Ellen Conlee, a lobbyist for the nurses. The longer period was a recommendation from a study group of the state nursing board, she said.
Jerry Slaughter, executive director of the Kansas Medical Society, the state’s leading doctor group, said he saw no reason to change the state’s current law dictating nurse practice arrangements.
“The system we have today has a long history of working pretty well. It provides a high degree of flexibility (without) requiring over-the-shoulder supervision,” of the nurses by doctors, Slaughter said.
“We can’t support the (nursing group’s) proposal as written,” he said “There aren’t any limitations — at least that we’ve seen — in the bill that would restrict APRNs from doing anything that a physician does. For example, we don’t see anything in the proposed bill that would prohibit a nurse from doing surgical procedures.”
Holes in access to coverage
House Speaker Pro Tem Peggy Mast, an Emporia Republican, said she is among the legislators who support the nurses’ proposal, in part, because of her own family’s experience with patchy health care access in the northwest part of the state.
Mast said her daughter went into premature labor over a weekend while she was in the Norton area.
“She went into labor and we ran her into the hospital, but the closest doctor that was there actually flew in from Wichita in order to take care of her. This is what we’re seeing occur in what we call the ‘frontier’ areas — where the nurse practitioners are really called upon to fill that gap, that need for good care,” Mast said.
“We realize we already have a shortage of individuals who can provide medical care in rural areas,” Mast said. “This (concept) has already been proven in other states that have expanded scope of practice. So I do support the expansion of scope of practice for nurse practitioners.”
Barrier to care?
Douglass of the Kansas APRN Task Force said the change in law was essential if access to care is to be improved in rural Kansas and other underserved areas.
She said the current law’s restrictions are blocking some efforts to provide or expand services. She gave the example of a psychiatric nurse practitioner she knows that is trying to start a practice in Garden City.
“Psychiatrists are scarce in western Kansas, let alone find one who will sign a practice agreement,” Douglass said. “This nurse practitioner found a psychiatrist to sign an agreement, but at a price: $16,000 per year. How does that ensure safe care? Fees paid to physicians to sign an agreement only add to healthcare costs.”
But the Kansas Medical Society also has characterized the nurses’ initiative as driven more by dollar considerations than patient care.
“Despite their (the nurses’ ) claims to the contrary, their bid for an unlimited scope of practice unnecessarily puts business pursuits ahead of patient safety and quality care. APRNs can practice in rural, underserved areas now, if they choose,” the society said in its most recent newsletter to members.
A 2011 report from the Institute of Medicine, found that among other things, “Restrictions on scope of practice … have undermined (nurses’) ability to provide and improve both general and advanced care.”
A 2012 report from the National Governors Association said that APRNs could expand access to care, particularly in underserved areas:
APRNs “may be able to mitigate projected shortages of primary care services … Existing research suggests that NPs can perform a subset of primary care services as well as or better than physicians.”
In March, the Federal Trade Commission cited those two reports and others in a letter to the Connecticut legislature, which was considering a bill similar to the proposal the Kansas nurses are offering. The letter, in part, read:
Removing (the collaborative practice) requirement has the potential to benefit consumers by expanding choices for patients, containing costs, and improving access. Accordingly, we encourage legislators to consider whether the existing requirement is necessary to assure patient safety in light of your own regulatory experience and the expert findings of the IOM, as well as the literature review and conclusions of the National Governors Association.
Maintaining an unnecessary and burdensome requirement is likely to deprive consumers of the benefits that increased competition can provide. Therefore, the Connecticut legislature should carefully consider the safety record of APRNs in Connecticut. Absent countervailing safety concerns regarding APRN practice, (the bill) appears to be a procompetitive improvement in the law that would benefit Connecticut health care consumers.”
Anticompetitive?
Americans for Prosperity-Kansas, an anti-tax group that champions limited government, is supportive of the nurses’ bill, said Jeff Glendening, the group’s director.
“It’s allowing for the free market in the occupational licensure world,” he said. “If I’m in town, I will definitely be testifying along the lines of this being a great example of economic freedom in action and the benefits of the free market, where people in underserved areas will have more options.”
AFP-Kansas also is supports a similar proposal to expand the scope of practice for dental hygienists.
Those two issues are among the three health policy issues that AFP-KS is focusing on this year, Glendening said. The third is the group’s opposition to Medicaid expansion “on the grounds that it’s expanding Obamacare,” he said.
(AP) – A Missouri Senate committee is considering whether to extend constitutional protections against unreasonable search and seizure to electronics.
Sen. Rob Schaaf, a St. Joseph Republican, said Monday the Missouri Constitution needs to be updated to reflect technological changes during the last century. Missouri’s current constitution was drafted in 1945.
Schaaf’s bill would add “electronic communications and data” to persons, effects, homes and papers as items protected against illegal searches. Schaaf says he introduced the proposed constitutional amendment after learning about the National Security Agency’s data collecting practices.
No one testified against the measure at a hearing Monday. If passed by the Legislature, the proposed amendment would go on the statewide ballot in November.
(AP) – Missouri transportation officials are taking a closer look at how freight can be moved more efficiently across the state by trucks, barges, planes and trains.
The Department of Transportation plans a series of forums across the state in the next two weeks to help develop a “Missouri Freight Plan.”
The plan will identify the freight projects that could be most helpful to the state if additional money becomes available. A draft is to be done by June and a final report by September.
That would come in advance of a potential November ballot measure asking Missourians to impose a 1-cent sales tax to raise money for roads, bridges and other modes of transportation.
The Department of Transportation says Missouri exported about $14 billion of freight in 2012.
– U.S. Senator Claire McCaskill, a former sex crimes prosecutor, has released the following statement in response to a news report by ESPN’s Outside the Lines about the alleged sexual assault, and subsequent suicide, of a University of Missouri student:
“As a mother of a daughter in college, my heart breaks for this young woman and her family. We must create a safe space for all women to report sexual assault to law enforcement-and no matter who the alleged perpetrator is, there must be a thorough and professional investigation. There are real questions about why none of that happened in this case, and it’s important the University figure out why and what must be done to fix it.”
Congressman Graves presents the first place certificate to Nina Bui.
Congressman Graves presents the second place certificate to Bailey Becvar.
Congressman Graves presents the third place certificate to Reid Walker.
Students who participated in the annual Congressional Art Competition gathered at a reception in St. Joseph, where Congressman Sam Graves (MO-06) applauded their work. At the gathering, which was held at the Northwest Missouri State University St. Joseph Center, Graves recognized several of the young artists for their work, noting three honorable mentions and announcing the first, second, and third place winners.
The following works were selected for awards:
· First place:“SPEAK,” by Nina Bui, Staley High School, Kansas City
· Second place:“Heart in Your Hands,” Bailey Becvar, Staley High School, Kansas City
· Third place:“Money,” Reid Walker, Platte County High School, Platte City
“Every year I continue to be impressed by the skill of these young artists,” said Congressman Graves. “The paintings, drawings, and photographs this year were all excellent. I congratulate all of the participants and in particular those who received awards.”
Congressman Graves’ office has partnered with Northwest Missouri State University for the past four years to participate in the competition. The first place piece will be displayed in the Cannon Tunnel at the U.S. capitol complex, along with artwork from other Congressional districts throughout the country. In addition, Ms. Bui will receive a $500 art scholarship to NWMSU. The second and third place pieces will hang in Congressman Graves’ Kansas City and St. Joseph offices, respectively, for the next year.
By John Schlageck, Kansas Farm Bureau
