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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  • Julie Holley, FNP-BC

    Clearly uneducated about the role and education of Nurse Practitioners.

  • NP

    Wow...there is some really poor education here. I am an emergency medicine NP. I have 6 years of experience, a doctoral degree, 2 board certifications and the same ancillary certifications as my physician peers. My education was geared towards rural emergency medicine and I am a specialist in that area. I am not the "town doc", or a moonlighting resident (who works under supervision when he/she is working within his/her specialty).
    I came up the ranks in healthcare one rung at a time, starting over 20 years ago as an EMT. Military PAs and NPs see trauma patients in Afghanistan. ..why are West Virginia residents any different?
    Its time to realize that medical school is only one route to being a competent healthcare provider, but from reading some of the ignorant drivel on here it is clear that West Virginians have a lot to learn before skilled NPs and PAs would chose to move to WV. I will stay in Arizona, and continue to staff my rural ER, where we have a survival rate from trauma that exceeds the physician staffed rural facilities in our area every year. BTW...NPs in Arizona are independent health care providers...and the closest physician emergency department is 75 miles away. ..and an hour closer to trauma centers in the city.
    So before you doom your friends and family members to substandard physician some research. NPs kick butt...and we still generally go by our first names...and we typically leave our egos at the door.

  • Morgan

    With regard to the title of this article and how it frames the issue and in response to some comments here: advanced practice nurses don't want to be doctors, or they would have gone to medical school. The practice of nursing and the practice of medicine are different things. Yes, they both deal with the health and wellness of their patients and they have similar knowledge about how the human body works and how to manage health and illness, but the professions are different. The philosophy of care is different, the education is different, the approach to patients is different. A very basic way to explain these differences is that medicine focuses on treating the disease or condition itself, while nursing focuses on treating the person who is experiencing health or disease.
    I am a registered nurse who plans to pursue an advanced practice degree and work in an under-served area of southern WV. I chose nursing over medicine very deliberately and thoughtfully, because of those differences in practice and philosophy.
    Nurse midwives and nurse practitioners are educated and trained to provide primary care to their patients, refer to other healthcare providers when needed, and consult with medical or nursing colleagues when issues arise that they unfamiliar with. All good healthcare providers should do those things. The collaborative agreement is a barrier that does not provide for a higher level of care, but does prevent some APRNs from practicing to the fullest extent of their expertise.
    West Virginia has a shortage of healthcare providers in many areas of our state; we need more primary and maternity care providers. Nurse practitioners and nurse midwives can fill those needs by providing care that is proven to be safe, high-quality, and cost efficient. Removing barriers to practice for APRNs is in the best interest of the citizens of WV. I hope lawmakers can see past this professional turf war and heated political rhetoric and do the right thing for the people of WV.

  • Billy

    Why not they do all the work anyways. I don't remember the last time I saw my MD, nothing but Nurse Practioners. Also I mean you let PT's take the name "Doctor" might as well yet a nurse be my "Doctor". What does it matter anyways big Pharma just needs to get more pills in the hands of people.

  • I'm honest at least

    If I pay to see a doctor that's what I should see. If I pay to see a nurse the cost of my visit should be a little cheaper.

  • Jennifer Westfall

    I have been an APRN for 12 years. I have no aspiration to be a physician. I know my limitations and if you are a patient beyond my expertise, I will send you to the appropriate provider to help you. With another 80,000 patients in an already overburdened system, who will you go to when you are sick? Anyone out there tried to get a new family doctor? Good luck. They are overwhelmed. Get an appointment with your doctor (not their mid level your doctor) when sick? Not likely. See you next week. The people of this state need competent providers. Here we are. Help us so we can help you!

  • WV Nurse

    This is not about allowing Advance Practice Registered Nurses (APRN) to write prescriptions for their patients, they've been safely doing this for over 20 years. This is about removing an archaic written agreement that serves no purpose other than make it harder for the citizens of WV to obtain health care.
    APRNs are regulated by the board of nursing and have passed national certification. They collaborate professionally with physicians and other health care professionals to make sure their patients have the best care possible.

  • Heidi

    I think there needs to be a closer look taken here. I think there is a classification of nurse practitioners and PA's that are essentially the front voice for specialists, whose time is stretched so thin already. I have been treated by primarily PA's and nurse practitioners in both general medicine and OBGYN for the last10 years. I was a high risk patient, and when the risk peaked, Drs. were available, but when i was going through the process of care and was not emergent, I received the highest quality of care by nurse practitioners. Care, I feel, was made better by the level of training that nurse practitioner had above and beyond the standard RN or LPN schooling.

    Also, with my daughter who has hydrocephalus, we would NEVER receive the care she needs without those nurses and their privileges. With one (just recently 2) pediatric neurosurgeons in the entire state, it is simply impossible for them to see each patient at every appointment that is needed or required for the constant monitoring and care needed for such high risk patients. But having a highly qualified nurse practitioner with years of experience working aside such doctors gives both the patient a source of consistent and highly qualified care and the Doctor the chance to save more lives.

    I can attest, from personal experience, that a nurse practitioner has saved both my life and my daughter's life by being the eyes and ears of the doctor they work beside or simply by being good at what they do and having the privilege above and beyond the standard training.

  • Elizabeth Baldwin

    APRNs are advanced trained nurses this training involves using medication from all schedules. but states like WV limit them from providing care to the full scope of their educational abilities. APRN
    Have been studies more than any other profession in independent practices for 40 years and have been proven to give save effective nursing care. the report included the studies but Mr Alred chose to inset his opinion rather than fact. APRNs want to practice advanced nursing of which medications are only 1 tool they use
    APRN want to be part of the solution to the drug problem in WV by increased monitoring of these medications and forming relationships and contracts with those in need of control substances.
    this is the evidenced base recommendations of the DEA.

  • Debra

    Someone is going to be at the bottom of every class. That does not mean that they're not competent in their field. You could have a class of Rhode scholars, and someone will still have to be in the bottom of the class. I have been treated by doctors, PA's and nurse practioners. The PA's and practioners are more attentive and are totally appropriate for sore throats, rashes and such. This is good common sense with the large amount of people comming into the health care system.

  • steve

    why not let them write for antibiotics only as this is the majoirity of office visits anyway--sore throats- etc.

  • WV Worker

    I think this would be a good idea.
    I also believe that they should allow bartenders to practice psychiatry, since many of them have to listen to peoples problems already.

  • CaptainQ

    Bet the medical fees we'd all pay for care from APRN's would still be the same as fully licensed doctors! ObamaCare probably doesn't even address this issue at all.

    • Jennifer Westfall

      Actually they bill at 85% of physician rate

  • Mtneer001

    I know that in other states like North Carolina and Virginia, that urgent cares use a lot of Physician Assistants in place of doctors. PA still have to attend medical school, but don't intern and do residency as long as a doctor.

    They have more education than nurses, but not quite as much as a doctor.

    I would think that would work well here in West Virginia.

    • Jennifer Westfall

      A nurse practitioner requires a masters degree or at least 6 years of college education. A PA can be 4 or 6 years so often a nurse practitioner has more education than a PA

  • Jay

    "Should a nurse be your family doctor?"

    One-word answer: No.

    Two-sentence rationale: If you want to play doctor, go to medical school. Simple as that.