Moves responsibility for licensure and regulation of nurse practitioners from the Boards of Medicine and Nursing jointly to the Board of Nursing. Also, creates the Advisory Board of Nurse Practitioners and removes certain physician supervision requirements.
Since SB 263 failed and was left in the Senate Education and Health Committee on February 16th, we hope that the bill will be revisited and reevaluated next session.It might be beneficial to change the direction of the bill since the Board of Medicine is a very powerful organization and they are in opposition of SB 263. An advisory board should be created, but nurse practictioners may need to stay under the Board of Medicine.This bill will most likely not pass if the Board of Medicine doesn’t change theirposition.
Family practice physicians are the lowest paid physicians. The field of primary care is starving for physicians since most doctors are specializing in specific areas where they can receive higher pay. SB 263 would allow Nurse Practitioners to work as primary care providers and increase the size of the field. Supporters of the bill should continue promoting SB 263 by advocating this point and other benefits of the bill.
R. Steven Landes’s legislative aid, Judy Wyatt, responded to our email in regards to SB 263. R. Steven Landes stated that he is aware that the bill was left in the Senate Education and Health, thereby killing it for the session. SB 263 never made it to the House Floor to be voted on. Although the session ended last week, his aide provided us with a link to track the 2010 legislation session online at http://legis.virginia.gov. We thank Judy Wyatt and R. Steven Landes for their response and information relating to SB 263.
Senator George Barker responded with gratitude for our inquiry regarding SB 263 and informed us that he is particularly supportive of nurse practitioners having the latitude and responsibility in the future. He did inform us that the bill was considered by the Senate and was declined. However, he also included that Senator Whipple may want to work on this issue during the rest of the year, and maybe reintroduce the bill next year. He will look carefully at any bill regarding this issue that may come to the Senate in the future. We thank Senator Barker for his support and kind response.
Mary Korving, Legislative Assistant to Senator Frederick M. Quayle responded to our email concerning SB 263. She said, “thank you for your e-mail. SB 263 was left in the Senate Education and Health Committee on February 16th, which means it has failed.” We were aware that SB 263 has failed for the year, however, we hope that by raising awareness and interest in this bill, it will pass in the next session.
Medical Society of Virginia (MSV): MSV has worked strongly and decisively against this bill. Concerning SB 263, MSV has stated that, “Such practice is not consistent with NPs level of the commonwealth.” Because MSV is a strong opposing force, it is vital for us to contact them and provide education about and support for the bill.
Legislators
Mary Margaret Whipple: Mary Margaret Whipple represents the 31st District in the Virginia State Senate. She is the chief Patron of SB 263 as well as the Chairman of the Education and Health committee. She is also involved in several other related committes. As the Chief Patron of this bill she is vital to gaining support for this bill and the passage from committee to the Senate and the House. She is also an advocate for several other bills that will improve the public’s access to health care.
R. Steven Landes: Delegate R. Steven Landes represents the 25th district of Virginia House of Representative. He is a member of several committees and subcommittees that are of interest to this bill. As Co-Patron of the SB 263 and a member of Education Committee, he will be of great importance to the passing of the bill. In the 12 years that Landes has served as a delegate, other committee members have come to rely on him to represent them on countless legislation.
Senate Education & Health Licensing Subcommittee Members: Virginia SB 263 has been assigned to the Senate Education & Health Licensing subcommittee. No decision was made about the bill and it has been left in Education and Health. The following are members of the subcommittee: Quayle (Chairman), Lucas, Martin, Barker, Northam. These members are key proponents and are essential to the future of SB 263. Since the bill will begin in this subcommittee next year, these members have to approve the bill before it can progress.
In the month of February, 2010 nurse practitioners presented their case for the passing of Virgnia Senate Bill 263 to a subcommittee of the Senate Education and Health Committee. Physicians also presented their case in opposition to SB 263. Unfortunately, the senators failed to make a motion for any action on the bill. Consequently, the bill has died for the year. Although there will be no further action for the passing of SB 263 during this year, we are still in full support for its passing in the future.
Political Action Plan: -Contact key legislators listed below to increase their knowledge on this bill -Distribute information to Medical Society of Virginia in an attempt to provide more education and support for the bill -Contact the American College of Nurse Practitioners and the Virginia Council of Nurse Practitioners to promote awareness of the bill -Spreading the word electronically about our blog and increasing awareness of this bill by educating our friends and family
Key Stakeholders: -Board of Medicine -Board of Nursing -Medical Society of Virginia (MSV) -Physicians -Individual Nurse Practitioners -Patients
Key Legislators: -Senator Mary Margaret Whipple (D- 31st, Arlington) introduced SB 263 -Delegate R. Steven Landes is the House Patron -Senate Education & Health Licensing Subcommittee Members: Quayle (Chairman), Lucas, Martin, Barker, Northam
We are in support of S.B. 263. Senate bill 263 would move NPs solely under the Board of Nursing and create an advisory board of physicians, pharmacists, and nurse practitioners to advise the Board of Nursing. This would remove the requirement for physician supervision and would open up more access to care in some free clinics, rural clinics, and federally qualified health clinics that have been limited due to current statutes and regulations. A broader definition of the scope of NP practice would enable expansion of primary care services to better serve the healthcare needs of the nation. As nursing students, we believe this would positively impact individuals by providing more patient centered care, advice on self care and management and more preventative services leading to better patient satisfaction. In the article titled, “Nurse Practitioner: Reflecting on the Future” (2008) Health service researches have studied the effects of NPs as an alternate source of medical manpower and have found that “NPs have provided continuity of care, where care has previously been fragmented. NPs are generally well accepted by consumers and have provided a level of performance that compares favorably with physicians as judged by standards developed within the practice settings.” Senate Bill 263 could make Nurse Practitioners primary care more economically viable while devoting extra attention to patients whose insurance pays less leaving physicians free to see more patients who are commercially insured (Sherwood, Brown, Fay, & Wardell 1997).
If this bill passed, the regulatory responsibility of Nurse Practitioners would be moved from the Board of Medicine to the Board of Nursing. Two political organizations that have been very outspoken about this bill are the Medical Society of Virginia (MSV) and the Legislative Coalition of Virginia Nurses (LCVN). The MSV believes that Nurse Practitioners do not have the education to allow this expansion of their scope of practice and that this issimply not in the interests of health, safety, and welfare of the citizens and patients of the commonwealth (Dan Carey, February 5, 2010). The LCVN states that this expansion would allow Nurse Practitioners to practice fully within their scope of practice. They believe that this change is long overdue and will expand the general public’s access to health care. Unfortunately, this bill has been defeated for the year in the Senate Education and Health Committeeand will not have another chance to be voted on until next year.
On Thursday, February 3, 2010, nurse practitioners advocated for their bill SB 263, which would have removed barriers to access to care by nurse practitioners. The purpose of the bill would be to move the regulation of nurse practitioners from the Boards of Nursing and Medicine to the Board of Nursing. An update of the code of Virginia wishes to regulate contemporary practice patterns in order to adjust the “supervision” requirements of physicians and provide regulations related to the relationship between nurse practitioners and physicians. If this bill were to pass, nurse practitioners would be permitted to practice within their full scope of practice consistent with their education. This would broaden the eligibility for Nurse Practitioner prescription medicine prescribing, increase consumer access to quality healthcare, and foster nursing workforce development.
For many decades, the focus of healthcare has been on the management of acute illness. Now, health promotion, disease prevention, and chronic disease management has shifted the focus of healthcare to be more patient-centered. Nurse practitioners can treat patients, diagnose ailments, and prescribe medications at a lower cost than doctors (Pickert, 2009). SB 263 would not only impact nurse practitioners, but also physicians, nurses, patients, and the entire health care system.
Doctors in some cases have lobbied to restrict nurse practitioner’s services. “In some situations, it can be a turf battle,” says Rebecca Patton, president of the American Nursing Association (Pickert, 2009). It is suggested that nurse practitioner training is inadequate and that nurses should retrain as doctors (Knight, 2008). Many physicians are against this bill because they fear the potential loss of patients. If nurse practitioners were able to practice independently, their role would move from that of a physician’s inferior, to a competitive member of the health care system. Some physicians feel like they worked harder to achieve medical status and this bill threatens to allow nurse practitioners to practice almost as an equal. On the other hand, a broader definition of the scope of NP practice would enable expansion of primary care services to better serve the healthcare needs of the nation (Sherwood, Brown, Fay, & Wardell 1997). Nurse practitioners have been found to give more advice on self care and management and give better patient satisfaction (Burke, 2009).
From a client perspective, many patients prefer seeing a NP because they feel they receive more patient centered care and preventative medicine. Some research suggests that NPs spend more time per visit with their patients than physicians, although the average number of visits per patient was equivalent (Sherwood, Brown, Fay, & Wardell 1997). Conversely, some patients prefer doctors for their technical skills and would rather see a physician if they think their symptoms are serious.
There is also the financial impact of this policy change to consider. Medicare reimburses nurse practitioners 85% of what is paid to doctors for the same services.
Currently, Nurse Practitioners (NPs) are supervised by physicians regardless of their education and experience. The statutes governing nurse practitioner practice have not been updated since 1973. Virginia is one of only 12 states that require physician supervision. Research shows that Nurse Practitioners provide safe, high quality care with excellent outcomes and patient satisfaction. Senate Bill 263 seeks to remove the supervision regulations and allow Nurse Practitioners to practice independently under the Board of Nursing.
Need for change
The current standard has allowed for the modification of policies and procedures that negatively impact patients’ access to care from Nurse Practitioners. For example, some offices and clinics have been forced to close due to the lack of a “supervising” physician. In some areas, these Nurse Practitioners may have been the only health-care providers available making it increasingly difficult for patients to receive health care services and medications.
Another alarming problem with the existing regulations is that for a NP to have prescriptive rights, their supervising physician must only oversee a maximum of four NPs and must “regularly practice” in each of the same settings. These strict limitations hinder the autonomy of NPs and shrink their scope of practice. In addition, if the physician is unable to provide regular services, patients will be unable to receive their medications in a timely manner.
Since the regulation of NPs has not been updated in the recent years, it is in critical need of modernization. In Virginia, the Boards of Nursing and Medicine jointly license and regulate NPs. Virginia is one of only 7 states that require joint regulation. There is no evidence to support the necessity of dual regulation. Due to the differences in nurse and physician education and practice, the Board of Nursing is better equipped to regulate NPs than the Board of Medicine.
Solutions
SB 263 would allow the Board of Nursing to develop guidelines for Nurse Practitioners to perform within their scope of practice and optimally function as a member of the interdisciplinary healthcare team. Ideally, changes in regulation will allow Nurse Practitioners to function as an equal partner rather than under a physician’s supervision. These provisions will enable effective, safe, and timely care to patients. Additionally, Nurse Practitioners would be able to prescribe drugs and devices consistent with their education and certification governed by regulations developed by the Board of Nursing in consultation with the Board of Pharmacy.
