Virginia law promotes team-based care by doctors and nurse practitioners

Physician organizations and nurse practitioner groups often find themselves on opposing sides of legislative scope-of-practice debates. But in Virginia, both sides worked together to craft a law that outlines how they will partner to provide team-based care.

The Medical Society of Virginia and the Virginia Council of Nurse Practitioners collaborated for nearly two years on the effort. In doing so, they found that they were able to work toward common goals, said Michael Jurgensen, the society’s senior vice president of health policy.

“In those conversations, we began to understand one another much better,” he said. “We were able to come to a mutually agreeable compromise.”

Their work should serve as a model for other states seeking to reinforce the important and long-standing relationships between physicians and nurses, said American Medical Association President Peter W. Carmel, MD.

“The AMA is pleased that Virginia’s new law supports consultation and collaboration among physicians and nurse practitioners while promoting physician leadership and management of patient care teams,” Dr. Carmel said. “The AMA encourages other states to consider following Virginia’s innovative approach as a way to ensure that patients have the best possible access to quality health care.”

The law calls for nurse practitioners to consult and collaborate with physicians, while defining the physician as the leader of the health care team. “We wanted to assure that the primary goal of patient safety was at the center of whatever we were putting in place,” said Cynthia C. Romero, MD, MSV immediate past president and a family physician in Virginia Beach, Va.

The law also expands to six the number of nurse practitioners a doctor can partner with and allows NPs to work in locations separate from their team physician, such as nursing homes and free clinics in medically underserved areas, said Mark Coles, RN, VCNP chair of government relations.

“A lot of employers will have more options to use their nurse practitioners with more flexibility,” he said. “You can put a nurse practitioner 50 miles away to serve a wider population where a physician is not available to go.”

But the American Academy of Nurse Practitioners opposes the new law, saying it “moves Virginia further out of step with the rest of the nation.” A major concern is the law’s linking of nurse practitioners’ ability to get a license with being part of a health care team under the leadership of a physician, said Tay Kopanos, DNP, NP, the academy’s director of health policy and state government affairs.

“Team-based care is a collaboration of various professionals around the needs of a patient and should not be thought of as a physician-led effort or a licensure construct,” Kopanos said.

Protecting patients

The MSV and VCNP began working together at the request of the Virginia General Assembly. If health system reform moves forward, 250,000 to 400,000 uninsured Virginia residents will gain insurance coverage, Coles said.

Before the new law, NPs had to work under direct supervision of a doctor in the same location, and physicians could partner with up to only four nurse practitioners. The changes better enable NPs to serve expanding patient needs, he said.

“The bottom line was to put the patients first and to do what was best for the patients,” Coles said.

The language of the law is flexible enough to meet today’s needs and adapt to future needs, Jurgensen said. The legislation became law on March 10. The state’s Joint Boards of Nursing and Medicine have until July 1 to draft regulations under the law.

Whether other states will follow Virginia’s example remains to be seen. Coles said he does not think the law can serve as a model for other states, because it was written to address challenges specific to the state. “The bill is tailored to the unique language that existed in Virginia,” he said.