Senate Bill Would Enable Veterans Affairs Nurse Practitioners to Practice Independent of Physicians

As reported by Modern Healthcare, the Senate is considering legislation that would allow nurse practitioners across the Veterans Affairs Department (VA) to practice independently of physicians, regardless of the state law where they are practicing. The bill, known as Frontlines to Lifelines Act of 2015, would allow advanced practice registered nurses – specifically nurse practitioners, nurse midwives and clinical nurse specialists in mental health care – to practice independent of physician supervision regardless of the limitations in place under state law. Modern Healthcare reported that provider organizations have either supported or remained neutral on the bill. The American Association of Nurse Practitioners has supported the measure, as has veterans organization AMVETS. The American Medical Association has remained neutral to date. The change comes after complaints of long wait times and delays in care at VA hospitals and clinics around the country, as well as physician shortages.

Currently, 21 states allow nurse practitioners to treat patients and prescribe some medications without the supervision of a physician.   Most recently Maryland passed legislation allowing nurse practitioners prescribing authority for certain drugs without an attestation agreement (often referred to as a collaborative agreement) with a physician. As discussed by Modern Healthcare, state medical societies have historically voiced concerns over expanding nurse practitioner authority in other states on the basis that nurse practitioners do not provide the same quality of care as a physician. In Maryland however the state medical society known as MedChi did not voice opposition after amendments were made to the initial bill requiring less-experienced practitioners to utilize a collaborative agreement and providing a disciplinary basis for nurse practitioners who fail to refer or consult a physician when necessary.   Similarly, effective January 1, 2015, the state of New York also removed the requirement that experienced nurse practitioners (those with more than 3,600 hours of clinical practice experience) maintain a collaborative agreement with a physician. Instead these nurse practitioners are required to maintain an established relationship with a physician or hospital for referral or consultation purposes. Proponents of “full practice” authority for nurse practitioners point to it as a low-risk healthcare solution to increase access to care in the face of the current shortage of primary-care physicians.

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