After years of trying, the West Virginia Nurses Association is just one step away from realizing its goal of removing barriers to allow them to utilize the full scope of their training to provide health care in the state. The legislature has given final approval to HB 4334 and sent it to Governor Tomblin.
The bill gives advance practice registered nurses (APRNs) “full practice authority” so they can do more of what they were trained to do. West Virginia would become the 22nd state to join one of the growing trends in health care delivery in this country.
The directional shift has been going on for years, but a critical moment occurred in 2010 when the Institute of Medicine released a landmark report calling for a change in the roles, responsibilities and education for providers.
“Regulatory and institutional obstacles—including limits on nurses’ scope of practice—should be removed so that the health care system can reap the full benefit of nurses’ training, skills and knowledge in patient care,” said a summary of the report.
The proposed change here met stiff resistance from MDs. They raised concerns that nurses would be essentially practicing medicine, something the docs do only after many more years of training than the APRNs receive.
The doctors, and others including the law enforcement community, were wary of a provision in the original bill allowing APRNs to prescribe up to three days dosage of powerful pain medications. They feared the additional avenues for access to pain medication would worsen the state’s already alarming prescription drug addiction problem.
The nurses wisely agreed to have that authority stripped from the bill, though privately pointing out that the over-prescribing of pain medication did not happen under their watch.
Currently, West Virginia nurses must maintain collaborative relationships with physicians, but the bill reduces that to a three-year requirement and then the APRNs can operate more independently. The APRNs have long argued that the current requirement was often more paperwork than collaboration, and they will still have working relationships with physicians.
HB 4334 could be particularly helpful in West Virginia, a rural state with an unhealthy population where some have to travel long distances to see the doctor. Also, the Affordable Care Act means thousands of new patients in the state—most on Medicaid—are trying to find providers that allow them to have regular, convenient access to meet their health care needs.
Highly-skilled nurses have long been hamstrung by West Virginia law, while other states have already moved toward allowing these heath care professionals more autonomy. “APRNs do not want to leave West Virginia to practice at their full professional scope, particularly with the multitude of health problems the state faces,” said Beth Baldwin, a pediatric nurse practitioner and president of the West Virginia Nurses Association.
Congratulations to the APRNs and the West Virginia Legislature for reaching a sensible compromise on a bill that should help with the vital health care needs of the state while allowing these nurses to do what they are trained to do.