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Bill Would Give Virginia Nurse Practitioners More Autonomy

 A bill awaiting Virginia Gov. Ralph Northam’s signature would eliminate the requirement that nurse practitioners with a certain amount of clinical experience have a business contract with a physician who oversees them.

 Nurse Practitioner Kristin Andrs looks over some of her vitamins and supplements at her wellness center in Petersburg, Va., on Jan. 25, 2018. (AP/Steve Helber) The Associated Press

RICHMOND, Va. (AP) – Most Virginia nurse practitioners could gain the autonomy to practice without a physician’s oversight if Gov. Ralph Northam signs a bill the General Assembly passed with near-unanimous support.

The measure would allow most types of nurse practitioners with five years of full-time clinical experience to earn approval to practice without maintaining a contract with a physician who oversees them. Northam, who must act by April 9, is evaluating the bill, according to his office.

Nurse practitioners have specialized training to write prescriptions, make diagnoses and perform other tasks that go beyond traditional nursing duties. Virginia is currently among 12 states, mainly in the South, with the most restrictive supervision requirements for nurse practitioners, according to the American Association of Nurse Practitioners.

“Nurse practitioners do not want to be MDs, but they do want to practice to their full scope of training. They have been providing competent, safe health care to patients for years, often in settings where the collaborating doctors are many miles away or even in another state,” the bill’s sponsor, Republican Del. Roxann Robinson, said during a subcommittee hearing.

Supporters of the bill say current collaborative practice agreements, the contracts nurse practitioners must have their whole careers, are an unnecessary and sometimes costly burden. Doing away with them could expand access to health care in areas of the state that sorely need it, they say.

While the bill passed with broad support, including from outside groups, the measure also sparked intense debate and drew opposition from doctors.

The Medical Society of Virginia, the state’s largest association of physicians, has raised concerns about patient safety and quality of care. The group has lobbied the governor for a significant amendment to the version of the bill that passed.

“Every pilot is trained to fly a plane. But do you really want someone who’s been trained to fly a two-person Cessna landing your 747? It’s about having the right person in the right role,” one medical student said while speaking against the bill in a subcommittee hearing.

But some nurse practitioners say doctors are more concerned about protecting their income – and their turf.

“They’re worried about a nurse practitioner opening a clinic next door,” said Paula Hill, a nurse practitioner and clinical director of the Health Wagon, which provides free health care in underserved areas of Appalachia.

Physicians in Virginia can’t currently supervise more than six nurse practitioners at a time, so finding an available doctor has been a challenge for some.

“I delayed starting my business for having trouble finding a collaborating doctor,” said Kristin Andrs, a nurse practitioner who runs her own practice in Petersburg.