Virginia Nurses Today 2_20

www.VirginiaNurses.com | Virginia Nurses Today February, March, April 2020 | Page 11
Leveraging the New Nurse Practitioner Autonomous Practice Licensure Law
etc. Ms. Adamson states, “It has been such an easy practice change for us in
this setting.”
Rebecca Bates, DNP, APRN, FNP-C practices with the Adams Compassionate
Healthcare Network with only four administrative and clinical employees and
herself as the only paid clinician. The clinic provides medical services to lowincome
and uninsured individuals for free or at a low cost. The clinic has
volunteer providers including physicians and a medical director who owns his
own practice. Under a collaborative agreement, Dr. Bates had to ensure the
collaborating physician was available for consultation as needed. If he left the
country to visit his family overseas or was otherwise unavailable, she would
not be able to practice. With autonomous practice licensure, Dr. Bates is not
required to practice with a collaborating physician. Additionally, any NPs who
have obtained their autonomous practice licensure and wish to volunteer in the
clinic do not need to have a collaborative agreement with the medical director.
This reduces the required oversight and nullifies the limit on the number of NPs
a collaborating physician may have an agreement with at any one time.
Dr. Bates states, “Autonomous practice has allowed me to seamlessly
integrate my scope of practice into the workflow and the care I provide in the
clinic.” As a preceptor, her NP students learn to participate in clinical care and
consultation as any healthcare provider does. Mandating a single provider for
collaboration is an onerous and ineffective model that reduces access to care,
particularly in a vulnerable population such as the uninsured. “My students
now learn to consider which healthcare provider is the most appropriate for a
particular consultation; it is most often not another primary care provider.”
Teresa Tyson, DNP, FNP-BC, FAANP is the executive director of the Health
Wagon and Paula Hill-Collins, DNP, FNP-BC, FAANP is the clinical director.
The Health Wagon’s mission is to provide compassionate, quality health care
to the medically underserved people in the mountains of Appalachia. 98% of
the Health Wagon’s patients are uninsured. Drs. Tyson and Hill report that the
autonomous practice licensure law has removed a tremendous burden of “fear
of losing our collaborative physician” who is in his seventies though remains
active in practice. The new law has allowed them to add two additional NPs to
the clinic. Dr. Collins-Hill states, “The law also permits NPs to freely volunteer
without the requirement for a collaborative physician at the M7 Move Mountains
Medical Mission (formerly Wise RAM).” This event, held annually at the Wise
Fairgrounds, serves thousands of individuals who come to get needed free eye,
dental, medical and diagnostic services. The new law has increased access to
services provided by the Health Wagon.
contextual factors that may enhance or impede uptake. Finally, an organization
may implement and monitor the policy and practice changes associated with
autonomously licensed NPs. NPs are qualified to independently deliver highquality
care and already do so in 22 states plus the District of Columbia. 53
Embedding policies and practices that fully utilize autonomous NPs in the
organization increases primary care capacity and access to care.
Conclusions
The autonomous practice licensure law for Virginia NPs effective since
January 7, 2019, has the potential to mitigate the primary care workforce
shortage and increase access to care across the state. With delivery system
changes and full utilization of NP and physician assistant (PA) services,
the projected shortage of 23,640 PCPs by 2025 can be effectively mitigated. 1
Although NPs and PAs do not replace physicians, studies have shown that NPs
and PA practitioners can augment and expand physician capacity in many
care settings. 54, 55 NPs can manage 80 to 90% of care provided by primary care
physicians such as: take medical histories, conduct exams, order and interpret
tests, develop treatment plans, and provide preventive care. 56 Leveraging use of
autonomous licensed NPs in free and charitable clinics is a strategy to increase
primary care capacity to address the health care needs of Virginia’s uninsured,
Medicaid recipients and other vulnerable patients.
For a full list of references, please visit https://cdn.ymaws.com/
virginianurses.com/resource/resmgr/full_practice_authority_refe.pdf.
Debunking Barriers and Misinterpretations
Some physicians and professional medical associations have justified their
support for limiting NP SOP regulations on the grounds that they are necessary
for the health and safety of patients from non-physician providers. 52 The robust
evidence-based research presented in this article argues against this stance.
In its 2010 evidenced-based report, The Future of Nursing: Leading Change,
Advancing Health, the Institute of Medicine (IOM) called on states to eliminate
“outdated regulations and organizational and cultural barriers that limit the
ability of nurses… to practice to the full extent of their education, training,
and competence.” 39 Virginia state legislators have removed restrictions on NP
SOP with passage of the autonomous licensure law. It is now incumbent for
organizational policy makers such as credentialing and governing boards
to revise policies permitting NP practice to the fullest extent of education and
training. Failure to fully integrate use of autonomous NPs into healthcare
delivery models will be at the expense of accessible care for many vulnerable
individuals.
Institutionalizing Autonomous Licensed NPs
A first step in the process to institutionalize autonomous licensed NPs is
garnering professional and political support from diverse stakeholders in the
organization. Starting discussions with stakeholders, including the board of
directors, administrators, nurse practitioners, physicians and other healthcare
workers surrounding the new licensure law is necessary for buy-in and to
address any knowledge gaps or misperceptions. These discussions must include
participatory approaches with bi-directional communication. The systematic
presentation of the evidence-base on NP safety, quality and cost-effectiveness
can be a powerful tool to build support for policy change and to dispel
misconceptions. Implementation also commonly requires behavior change
among individuals or organizations, and therefore a deeper understanding of
the social, economic, institutional or cultural attitudes must be considered as
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