Political Influences

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 is simply 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 Committee and will not have another chance to be voted on until next year.

Government Objectives

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.

Potential Impact of SB 263 on Nursing, Clients, and the Health Care System

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.

The Importance of the Virginia Nurse Practitioner Bill

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.