CHARLESTON, W.Va. — A legislative audit recommends that advanced practice registered nurses in West Virginia be allowed to expand the scope of their care, but the recommendations do not go as far as the APRNs want.

Legislative Auditor Aaron Allred’s report suggests that further empowering APRNs to provide more primary care would help address the doctor shortage in West Virginia.  However, Allred stopped short of suggesting the nurses could operate independent of physicians.

Currently, APRN’s are allowed to form collaborative agreements with doctors who are supposed to provide clinical supervision.  Angy Nixon, a midwife from Scott Depot and member of the Board of Nursing, called these collaborate agreements “useless.”

She added that the nurses are simply asking for more autonomy.  “There is no change or expansion in scope of practice for any APRN,” Nixon told the House of Delegates Government Organization Committee, where the audit was released Thursday.

However, Allred said the APRNs want all restrictions on writing prescriptions removed, which he fears will worsen the drug problem in West Virginia.

“Given the addiction crisis we have in West Virginia, I cannot in good conscience recommend to the Legislature that 2,149 more individuals in West Virginia be allowed to write prescriptions for Class 2 narcotics,” Allred said.

Nixon countered that since APRNs are currently not allowed to prescribe powerful pain medication, they could not be held responsible for the current problems.

Allred’s audit does suggest that APRNs be given more independence, but he added that if the nurses want to practice at the same level as a family doctor, they should have to be regulated by the state Board of Medicine, a suggestion the APRNs strongly oppose. Nixon said that would mean one profession is regulated by a board from another profession.

The debate is timely given the dramatic changes in the health care delivery system in this country.  Just in West Virginia, more than 80,000 people have signed up for health insurance under the expansion of Medicaid, but it’s unclear whether there are enough providers.  All but five of the state’s counties are deemed by the U.S Department of Health and Human Services as medically underserved or as having a shortage of health care providers.

APRNs could help fill the gap.  They are currently allowed to diagnose and treat patients, but must have a written collaborative agreement with a physician in order to prescribe medicine from a limited drug formulary.

Some states have already expanded the scope of practice of APRNs, but Allred’s report did not find research that focused on the quality of APRNs in autonomous practice.   Allred says the American Medical Association and the Association of Osteopaths oppose allowing APRNs to practice independently.


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  • Laure Marino

    Thank you for the opportunity to contribute to this forum. I am a APRN for 17 years, all in the Kanawha Valley for the citizens of WV. NPs in the state advocate for a removal to the restraint of trade barriers on our practice by seeking legislative removal of the collaborative practice agreement. This document, between a physician and the APRN, is for the express purpose of prescribing medications. To clarify a message on your the show, we do enjoy broad prescribing of routine medications to treat diabetes, heart conditions, asthma. We do not prescribe C 2 agents.
    Mr. Allred is concerned about the expanded prescribing habits of APRNs as it relates to our prescription drug abuse problem. A review of the national literature does NOT support his fear. APRNs with the ability to prescribe narcotics with less restriction DO NOT write more of these prescriptions and have not been found to be a factor in the misuse of prescription narcotics.
    APRNs are an excellent resource to provide primary care to all citizens. We are ready and available. Numerous studies have shown that our patient outcomes are equal to or better than physicians. Furthermore, patients consistently report a higher level of satisfaction with their care visits with APRNs and have higher treatment plan compliance. WV should follow the lead of 15 other states in the nation who have legislated full scope of practice for APRNs. This improves access to care and improves the health of our citizens and communities and is consistent with national mandates from the Institute of Medicine and embedded into the Affordable Care Act
    Warm regards

  • Hillbilly

    You want to be a nurse, become a nurse.
    You want to be a doctor, become a doctor.

    Nurses are NOT doctors.

    • Gaspasser

      In 2015 almost all Advanced Practice Nurses will be educated to the Doctoral level.

      Nurse Anesthetist were the first providers of anesthesia in the US. Most Anesthesiologist I have personally worked with have not given a single anesthetic in many years.

    • 2XLPatriot

      This is not about Nurses becoming Doctors. It's not like they're trying to cheat the system and take an unearned title. It's about Advanced Practice Registered Nurses providing care at an ADVANCED LEVEL, WITHIN the scope of their practice. Years of education earning a Master's Degree or Doctorate. People need to seriously practice reading comprehension!

      • Jay

        I appreciate your point. However, at a certain point the practice of nursing is exhausted, and care activities that run so advanced blur the lines between APRN and doctor. In my opinion, prescribing medicine is too far beyond that line. I have family members who are physicians and many friends who are RNs. To me, the difference in their foci is stark. I am an advocate of a definition of "Advanced Practice" which does not include writing prescriptions or making diagnoses.

        • 2XLPatriot

          Not every person receiving medical care requires a Physician. That's the whole point. Let the advanced practice Nurses manage what they are capable of, within their scope of practice to lighten the load of the physician. APRN's have been writing prescriptions for years. The title of "Doctor" is not in line with "all mighty". Burnout rates occur because of Physicians taking on too many patients and it also results in a lower quality of care and more mistakes.

          • Jay

            *this issue

          • Jay

            We just fundamentally disagree on his issue, which is the essence of politics.

  • Kelly

    Remember that 50% of all doctors graduated in the bottom half of their class.

    • wvfreys

      and so did 50% of the nurses

  • Hillboy

    APRNs will increasingly become our first line of healthcare providers. We have no choice. One survey I read said that only about 7 percent of graduating med students intend to go into general practice. They make more money as specialists and have more prestige. According to the survey, even if they go into med school wanting to be a family practitioner they usually change their minds before they finish.

    With fewer med school graduates coming out as GPs and increasing demand due to the ACA it will be necessary for APRNs to fill the gap. And, I think that will be fine. They can handle the day-to-day stuff and refer the more complicated stuff to specialists, just like a GP does.

    As for the independent prescription authority, if I were an APRN I'd rather have an MD have final oversight just for malpractice liability reasons.

  • wvtd


  • 2XLPatriot

    As a Registered Nurse with no aspirations to become an APRN, I have to say this; There are good and bad in all levels of care from Nurses, Doctors and Physician Assistants. I have worked with Doctors and PA's who have no clue and are downright dangerous! I have worked with RN's who could take care of me or my family any day. Nurses listen and pay attention. We spend more time with patients and get the whole story rather than the complaint. It's called a holistic approach. Then, I have worked with Nurses who also have no clue. A competant APRN who has clinical experience and has worked their way through school will be an excellent provider instead of one who went straight through school into practice with no previous clinical experience. These are the ones to be wary of. It's not a terrible thing to give APRN's more autonomy and it's more efficient and cost effective. Most people complaining here are probably the ones who complain the most when they have to wait in an ER for a sore throat or earache while other, more ill patients are being treated first.

  • griff

    NO WAY, nurses are nurses Z& doctors are doctors. Let's keep it that way

    • Carol APRN

      Have you ever seen an APRN for your medical care?

  • Tim C

    One word answer - NO!....two word answer - H&$% NO!!!! They are not doctors and they are not qualified to act as doctors. This is a stupid idea. Two of my family have been diagnosed and treated by APRN's with pathetic results. Next, why don't we let barbers practice medicine like they did in medieval times?

    • mntnman

      Its family practice, not surgery for goodness sake. Most see PAs now when they go to their family practitioner; some practices have more PAs than Drs. Nurse Practitioners have higher credentials than PAs and most are more than competent to have a family practice. We need rural health care -- so we do without, or change some things. I vote we change some things.

      • The bookman

        I don't think anyone is claiming that these skilled nurses shouldn't be permitted to provide that level of service, just that they should continue to have a licensed physician as their sponsor. Could someone please explain why that is no longer possible?

      • leroy jethro gibbs

        most pa's and np's have masters degrees so i see no difference in their training , its all about experience. there are good np's and pa's and bad np's and pa's as there are good doctors and bad doctors. the issue is autonomy. i would rather see a pa or np that has a doctor backing them up. rather than one out on their own. if people want to be independant go to med school.. or maybe they arent smart enough to get into med school or are just too lazy

  • Cheryl

    I love my Nurse Practitioner! The best care I have received in many years. No one could ever persuade me to go to any one else now. My husband is also in complete agreement. Extremely happy with the quality and competency of the care we have received.

    • rose


      There are extremely competent Nurse Practitioners and there are some who aren't.

      Just like the doctors.

  • Alum

    This does not sound good to me. I have interacted with PAs before as a patient and the experience has not always been good. I do think the respective medical associations have this one right.

    • pw

      PA is not synonymous with NP......

      • Alum

        Nor is it synonymous with MD or DO.

    • ernie

      Experiences with doctors are not always good either.

      • Alum

        It's not about good or bad, it's about competence to diagnose and treat.

  • Medman

    There are APRNs and then there are APRNs. Just like every other profession, there are many who are competent enough to be allowed more independence in terms of primary care, but there are others who are marginal, at best. The answer to the manpower problem may be to upgrade the credentialing and monitoring of the APRNs to a level that assures quality care. I am sure this may not sit well with some of the current APRNs who would have to be re-certified.

  • Concerned

    Sure. As long as it's cheaper.

    • leroy j gibbs

      You get what you pay for

  • The bookman

    Encourage them to become full fledged physicians if they want to be independent. We do not need more individuals prescribing more meds to an already over prescribed population.

    • I'm honest at least

      +1 we already have health insurance companies trying to make pharmacists Drs.

    • leroy j gibbs


  • debbie

    go ahead the nurses I have worked with think they know more than the doctor anyway.

    • Alum

      Sometimes they do. The nurse sees the patient hours a day (in a hospital setting) while the physician see the patient for a few minutes. But nurses also know their professional limitations, I know because I am married to one.

  • mntnman

    Oftentimes I'd rather see the nurse...