Nurses are gaining ground with full practice authority

When nurses in Virginia decided to lobby for fewer restrictions on nurse practitioners (NPs), they knew that any changes to existing law would require an uphill battle with physician groups and legislators against expanding nursing practice authority.

Home to one in all the oldest legislatures within the Western Hemisphere, the state tends to be more conservative. The Medical Society of Virginia had significant influence within the political arena and opposed changes to existing law that required NPs to enter into cooperative agreements with physicians as a way to practice. Cynthia Fagan, DNP, RN, FNP-BC In 2018 Virginia Board of Nursing worked with lawmakers to introduce a bill that may allow NPs to practice independently after 1,040 hours – the equivalent of six months – of working with a physician. The council expected negotiations with physician lobbyists, and nurses were willing to extend the variety of hours of cooperation to three,000. But on the eleventh hour, the subcommittee chairman introduced a substitute bill requiring 9,000 hours – or five years – of cooperation. “I think the medical association thought we would reject this bill, but the change would still allow about 50% of nurses in the state to gain autonomy because they have been practicing for more than five years,” said Cynthia Fagan, DNP, RN, FNP-BC, chairwoman of the federal government relations of the Virginia Board of Nursing. “We have decided to support the bill.” Although Virginia is the one state that requires nurses to work with a health care provider for 9,000 hours before working independently, Fagan sees the brand new law as a victory for 2 reasons.

1. NPs may eventually transition to independent practice.
2. Lawmakers included a provision within the substitute bill stating that only NPs certified within the collaborating physician’s specialty could progress to independent practice. Fagan said the change would cut many nurses’ hours.

National progress in authority of practice

Virginia is now one in all 22 states where nurse practitioners can practice independently, and one in all 10 states which have lifted restrictions on NPs over the past 10 years. DC, Guam and American Samoa are also fully licensed to practice.

Expanding NP practice credentials became a high priority nationwide in 2010 when the Institute of Medicine released a report with eight recommendations to enhance health care within the United States. One of the recommendations focused on increasing access to care enabling nurses to practice their career with the complete scope of education and training.

In states which have lifted restrictions on nurses, nurses have learned from each successes and failures methods to influence policy decisions. In Virginia, one in all the keys to success was finding a legislator who was in favor of change. Roxann Robinson, a Republican within the Virginia House of Delegates, was perfect for the job because she was an optometrist who faced similar challenges with ophthalmologists, Fagan said. Volunteer leaders like Fagan also realized that combining advocacy work with a full-time job limited their effectiveness, so in 2017, the Virginia Board of Nursing hired a full-time executive director who could devote more time to the trouble. The organization also began offering webinars and other forms of coaching for members methods to engage in propaganda activities. Nurses began learning methods to interact with legislators and write letters to influential people, and 200,000 nurses wrote letters to the governor describing the issues of the physicians association’s proposed restrictions on who could qualify as an associate physician. Fagan believes these letters helped influence the governor’s decision to reject these restrictions.

Gaining public support for the complete authority of practice

In 2016, West Virginia nurses became fully licensed to practice law after three years of working with a health care provider, and lawmakers have worked with the Legislature for years to make the change.

“Even though nurses had accurate data and evidence to support this change, for a long time it didn’t seem to matter,” said Aila Accad, MSN, RN, executive director of the West Virginia Future of Nursing Action Coalition. “Doctors had more political support.”

AARP then agreed to work with West Virginia nurses to lobby for the proposed bill, and the organization asked the general public for support. Organizations reminiscent of West Virginians for Affordable Health Care, the West Virginia Council of Churches, and the National Association of Social Workers of West Virginia have joined the bipartisan effort to support this bill. “When it became clear to lawmakers that the bill had broad support, they passed it,” Accad said. In Pennsylvania, the state Senate recently supported a bill that may allow nurses to practice independently after completing a three-year, 3,600-hour collaborative contract with a physician. However, for the past two years, the bill has been stuck within the Occupational Licensing Committee, stopping the laws from moving to the House of Representatives, said Cheryl Fattibene, DNP, MSN, MPH, CRNP, chief nursing officer for National Nurse-Led Care Consortium.

“We already know we have the votes to pass the bill in the House, but it has never moved out of committee,” Fattibene said.

She knows there are political forces at work which will prevent work on the bill, but there may be reason for hope – she said a brand new legislator will chair the Professional Licensing Committee next yr.

For nurses working in states which have not adopted apprenticeship laws, joining a national organization reminiscent of American Association of Nurse Practitioners that is a vital first step towards further change, Fattibene said.

“Nurses can learn what’s going on in other states and gain access to people who can provide support in this work,” she said. While it might be tempting to get entangled within the day-to-day work of treating patients, she encourages nurses to take the time to coach each physicians and lawmakers concerning the issues involved. When she testified before a House committee two years ago concerning the advantages of power of attorney, the questions lawmakers asked were revealing. “I was amazed at their lack of knowledge about our scope of practice,” Fattibene said. “Regulations are often made by people who are not informed about what we do, and nurses need to speak up to educate people about the changes they can make in health care.”

Take these full practical authority courses:

Nurses have a responsibility to maintain up so far with current issues related to the regulation of nursing practice not only in their very own state, but additionally throughout the country, especially when their nursing practice crosses state borders. Because practicing as a nurse is a right granted by the state to guard those in need of nursing care, nurses have an obligation to patients to practice in a secure, competent and responsible manner. This requires nurse licensees to practice in accordance with the statutes and regulations of their states. This course provides information regarding nursing practices and their impact on nursing practice. This course will help advanced practice nurses meet the brand new ANCC requirement for 25 hours of pharmacology contact for recertification starting January 1, 2014. Written and rigorously peer-reviewed by pharmacists and advanced practice nurses, this course covers a big selection of medical conditions and medications. related to them. Chapter topics include hypertension, diuretics, gastrointestinal tract, intensive care, sexually transmitted diseases, asthma, oncology, non-opioid pain medications, diabetes, weight reduction, mental health conditions reminiscent of anxiety, bipolar disorder, depression, and lots of others. The chapters discuss the clinical uses, dosages, interactions, and unintended effects of commonly used drugs in practice. The chapters include APN tricks to assist you prescribe medications. The use of an interprofessional team approach has led to improved outcomes in certain patient populations and disease states. There are many various models and every could be tailored to the precise needs of the population. As healthcare reimbursement continues to evolve, a team-based approach could also be warranted to optimize patient care.