CHARLESTON, W.Va. — Advanced practice registered nurses in West Virginia would be allowed to do more with a bill that’s pending in the Senate Health and Human Resources Committee.

Currently, APRNs enter into collaborative agreements with doctors who provide clinical supervision.  APRNs can diagnose and treat patients, but must have that written agreement with a doctor to prescribe medication from a limited drug formulary.

The bill that would change that, SB 212, would eliminate the oversight mandate and expand the prescriptive authority of APRNs and certified nurse-midwives.  It’s a step that’s already been taken in 20 states.

“More and more states are jumping on board, realizing that this is a solution,” said Aila Accad, president of the West Virginia Nurses Association.  She said giving APRNs more autonomy would expand health care choices for West Virginians, help contain costs and improve health care access.

Accad, a guest on Friday’s MetroNews “Talkline,” estimated the costs of seeing an APRN are anywhere from one third to 50 percent lower than seeing a physician.  She said empowering APRNs to provide more primary care would also help address the doctor shortage in the Mountain State.

“Here in West Virginia, we’ve got a rural population that needs more access and it’s not the primary care physicians who are going out to the rural communities, it’s the nurses who stay in their communities,” she said.

A recent legislative audit recommended that, if nurses are allowed to practice at the same level as family doctors, they should be regulated the same way — through the state Board of Medicine.  APRNs have pushed back against that.

“We don’t have exactly the same training as a physician because we are two separate professions.  We operate under different parameters and the different ways we view the patients and their needs,” Accad said.

Concerns were also raised in the audit about expanding prescriptive authority to more people at a time when prescription drug abuse is rampant.

Those with the  American Medical Association and the Association of Osteopaths oppose allowing APRNs to practice independently.

The 2014 Regular Legislative Session will continue through Saturday, March 9 in Charleston.

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  • Chris

    As a Physician Assistant for 12 years I believe that there a physician association is a good thing for PAs and NPs alike. If we want independent practice then apply to medical school. We are not trained 100% equal to a physician. We as mid-levels do provide excellent care and access. I work with 2 great NPs and 3 great PAs and we work our butts off each day, but none of us can honestly say that we can diagnose everything. I feel very confident in my abilities and my Doc trusts my medicine but his Doctorate trumps my Masters degree. I really dont see what the drive is to separate very important collaborations

  • WV Consumer

    As the most trusted profession in the US for over 12 years why not trust nurses with our health. I just makes sense. Nurses listen to their patients, care for them in their homes and communities. I will trust a nurse anytime to help me manage my aging body.

  • APRN 4 Care Choice

    Great topic and wonderful guest.

    As an APRN I would like to put this issue in the framework of choice. Being cared for by someone you believe in, trust, and connect with is very important. If that is a physician, you should see a physician. As a nurse, my ultimate focus is the health of the entire community and for that to happen, individuals need to receive care. They will only do so if they are comfortable with their providers. So I absolutely support and respect primary care physicians and what they do.

    But there are a couple problems with the current system in WV (and around the country):

    1. Physicians in primary care are retiring and new physicians are not selecting primary care as a specialty. The result is less ability to ACCESS a primary care physician TIMELY.
    2. Because primary care physicians are already overwhelmed with patients, and reimbursements for government insurances aren't as high as private insurers, many primary care physicians are not accepting new Medicare and particularly Medicaid patients (at at time when WV has expanded Medicaid to an anticipated 125,000+ residents). Again, a cause of a reduction in ACCESS.
    3. The current law prevents citizens who prefer care from APRNs to have security in maintaining that relationship because the APRNs ability to practice is tied to a physician. If a physician decides to no longer collaborate or if something untoward should happen to their physician collaborator causing them to no longer being able to practice as a physician, an APRN's patients will lose their chosen provider.

    Over 40 years of research and over 100 studies have shown APRNs to be safe providers of care. There is no risk to the public for allowing APRNs to provide the care they are trained to provide.

    No one is saying anyone HAS to see an APRN; but let the very important decision of selecting a healthcare provider be made freely, and allow patients a choice on whom they prefer. Neither organized nursing nor organized medicine should take that decision away from the citizens of WV.

  • Deborah Casdorph

    I have been an APRN for 21 years. I see over 4500 patients a year and want to be able to practice without having a physician involved in order to prescribe the medications my patients need. If an APRN's "collaborative physician" should move, retire or pass away, he or she has to scramble to find someone or pay a physician in order to continue to practice. APRNs are trained, licensed and certified to practice and prescribe within their scope of practice but the Board of Medicine is determined to keep control of their practice even though APRNs fall under the Board of Nursing. I practiced for 15 years in a state that had total autonomy for their APRNs so I know that it works well. I strive to see WV lift the restrictions that are now in place as more people will receive that care they need in a more comprehensive and cost effective manner.

  • APRN and prescriber

    Good discussion - thank you for raising these important issues! This affects me, both as a health care provider (APRN) and as a consumer myself. I shop for my own health care based on value. I hire a physician when I have an injury or to treat pathology, and an APRN when I need wellness/preventive care and advice. As an APRN myself I prefer the longer visits, and a highter quality relationship with my patients. This makes my job very rewarding. I maintain a low volume of patients in my practice and I function more like a personal health coach, focused on wellness, less medication (a handful per month), and prevention. Most health problems are preventable! Patients can get appointments within a few days (not months). They stay healthy, can get treatment faster, and enjoy tremendous financial savings for themselves and their families - not to mention for their payors.

  • I'm honest at least

    If I'm going to pay to see a doctor then I want to see a doctor. No disrespect to nurses you all are wonderful most of the time.

    • APRN 4 Care Choice

      I'm honest at least:

      As an APRN I take no offense. If you prefer physician care I TOTALLY believe you should see a physician and support your choice. The relationship and trust you have with your healthcare provider is one of the most important, and often undervalued, relationships there is. So I'm happy you have access to your provider of choice.

      I just want to make sure that those in WV who want to see an APRN can do that. I have a primary care practice and have hundreds of patients that chose me to provide their care. However, if the physician that periodically audits my prescribing practices should suddenly die, be arrested, lose their license or decide they don't want to audit me any more I would have to close the doors to those people that prefer to see me.