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Dawn M. Adams column: It's time for Virginia to enter the current century: Modernize nursing
Health Care Perspectives

Dawn M. Adams column: It's time for Virginia to enter the current century: Modernize nursing

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Since the 19th century, nurses have been at the forefront of health care, answering the call to ensure the well-being of the people within their communities. As we confront the dire health workforce challenges of this century, nurses have stepped up to become highly educated, clinically competent experts to meet the increasing health demand of patients.

As a nurse practitioner myself and a member of Virginia’s House of Delegates, I can say that a lot has changed in modern nursing. We now have four categories of advanced practice nurses (APNs) — nurse practitioners, clinical nurse specialists, certified nurse midwives and certified registered nurse anesthetists. To become an APN, we first must have a bachelor’s degree in nursing. Once we become a registered nurse, we earn master’s degrees, and more and more nurses are earning doctoral degrees in nursing (as I did). All of this adds up to years of rigorous coursework and supervised clinical practicums. After completing graduate school, APNs take national certification exams and obtain Virginia licensure through the state Department of Health Professions. Nursing has its own standards of education, competency milestones and licensure requirements just like dentistry, law, medicine and pharmacy. Modern APNs have evolved with our changing society and health care needs. We deeply listen to patients, we empathize, we provide expert clinical care. We are extremely well prepared to take care of patients.

With all of this higher education, training and national certification in Virginia, we APNs still are not deemed “competent” when we enter clinical practice, at least not by organized medicine. Virginia restricts APNs from practicing to the full extent of their abilities. How? For one, the boards of medicine and nursing regulate APNs. This is not aligned with the national standards where each profession regulates itself. Do we have plumbers regulating electricians? Second, Virginia APNs are required to “prove” their competency by working an additional five years under the supervision of a physician. This is nonsense. There is no other example of this archaic, Byzantine requirement in any state in the country. Virginia has been deemed a “restrictive” state compared to other states that have kept pace with modern nursing. Third, Virginia invests in the preparation of scores of APNs every year through publicly funded universities. Yet once graduated, their practice is restricted by arcane laws and regulations. There are reports that some APNs, once graduated, leave the state to practice elsewhere due to these restrictions.

APNs have 40 years of effectiveness research and have shown over and over that they are safe, effective providers who improve the health of the communities they serve. In states such as Arizona, APNs are able to work to the top of their skill set (full practice authority), and there is no untoward effect on Arizonians as a result. Arizonians are not dying because of it, and there are no increases in malpractice cases.

In real life, separate from the sterile environment of the General Assembly, APNs and physicians work together and have strong, trusting, warm, collegial relationships all across the state. This year, I will submit legislation to make permanent the governor’s executive order to reduce the arbitrary mandate to limit APN licensure, so we independently can practice after two years instead of five, and allow clinical nurse specialists and certified nurse midwives to practice according to national standards. There is nothing extraordinary about these modest objectives, and it is time to align Virginia’s laws with modern nursing and health care with the rest of the country. It’s time to end Virginia’s outlier status, and give APNs the right to practice so that Virginians can access more competent health care providers.

Dawn M. Adams, D-Richmond, represents the 68th district in the Virginia House of Delegates. Contact her at:

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