By Ann F. Bennett, RN, MS, ANP
The Board of Nursing was notified that the University of Virginia was offering a nurse practitioner course.
In May, the Board of Nursing adopted the Statement of Belief and Proposal for the Extension of Nursing Practice in Virginia, recognizing the need for change in Virginia law and for regulation of nurses in advanced practice.
The General Assembly changed the Medical Practice Act authorizing expanded nursing practice under regulations promulgated by the Boards of Nursing and Medicine.
In January, six nurse practitioners (NP) met in Norfolk with the intention of organizing as a professional group.
The first Regulations Governing the Certification of Nurse Practitioners were adopted. Nurse anesthetists were included under these regulations.
The first NP certified was Barbara T. Walker, then Executive Director of the Virginia Nurses Association (VNA).
The Joint Boards of Medicine and Nursing Committee (Joint Boards) approved VCU/MCV’s OB/GYN NP Program and UVA’s Emergency Room NP Program.
Richmond organized a Nurse Practitioner Professional Practice Group (PPG) under the VNA.
Nurse Midwives were included in the Regulations Governing NP’s. There were then 11 categories of primary care NP’s, plus Certified Registered Nurse Anesthetist Practitioners and Certified Nurse Midwife Practitioners.
VCU/MCV’s Pediatric NP Program and UVA’s Adult NP Program were approved
The Board of Nursing recommended an advisory committee to assist the Joint Boards in their work regarding NP’s in the state.
The Regulations Governing the Certification of Nurse Practitioners that went into effect July 1, 1980 included 13 categories of NP (Adult, Family, Pediatric, Family Planning, Ob/Gyn, Emergency Room, Geriatric, Nurse Anesthetist, School, Medical, Maternal Child, Neonatology, Midwife).
These Regulations provided that the Joint Boards could appoint an Advisory Committee on the Certification of Nurse Practitioners composed of 4 NP’s and 4 MD’s to advise the Joint Boards on education and practice issues.
The first Mid-Atlantic Nurse Practitioner Conference was planned and held by the Richmond NP group.
Charlottesville, Tidewater, Southwest Virginia, Northern Virginia, and Lynchburg joined Richmond in becoming NP/PPG’s of the VNA.
The first NP representatives to the new Advisory Committee to the Joint Boards included Judy Collins, Patricia Rowell, Debra Sivertson, and Ronald Small.
The NP/PPG became the Virginia Council of Nurse Practitioners (VCNP), maintaining its association with the VNA. The change from PPG to Council status was within the VNA structure. Diane Hanna was the first VCNP president.
The General Assembly enacted legislation creating provisional practice status for NP’s pending certification.
The first VCNP Bylaws were developed and approved.
Professional certification of NP’s by a national certifying agency was required for state certification to practice as of July 1, 1986.
A 14th category of NP, Women’s Health Care NP, was added to the Regulations.
The VCNP formed the Coalition of Virginia Nurses in Advanced Practice (COVNAP).
A crisis occurred when it became impossible for NP’s to obtain malpractice insurance. Judy Collins participated in the resolution of this problem.
The status of NP’s in the state changed from certification to licensure. NP’s became Licensed Nurse Practitioners (LNP) through change in the regulations, which had become the Regulations Governing the Licensure (vs. Certification) of Nurse Practitioners. In addition, the regulations were becoming less restrictive to NP practice through modification of the definition of supervision in the working relationship between NP and MD.
Changes in the law made it possible for Psychiatric Clinical Nurse Specialists to receive reimbursement, which was the first opportunity for APN’s to get reimbursement.
The VCNP joined the American Academy of Nurse Practitioners.
The General Assembly changed the Medical Practice Act and the Drug Control Act, giving prescriptive Authority to LNP’s for Schedule VI drugs.
The Advisory Committee to Assist with the Promulgation of the Regulations for Prescriptive Authority was formed. The LNP representatives on this first committee were Judy Collins (Chair) and Sharon Bailey
Judy Collins became the first LNP to sit on the Board of Nursing.
Nurse Midwives could obtain hospital privileges.
The new Regulations Governing the Licensure of Nurse Practitioners had included material on prescriptive authority, and by September, 24 LNP’s has obtained prescriptive authority.
VCNP began to consider contracting for administrative assistance services.
Diane Hanna chaired the Board of Health (1993-95), the first nurse to hold that position.
Prescriptive authority went into effect in January.
The Mid-Atlantic Nurse Practitioner Conference became the Virginia Council of Nurse Practitioners Conference, initially rotating responsibility for the annual education conference among 3 regions, each formed of 2 regional groups.
Janet Younger RN, PhD, LNP was appointed to the Board of Nursing. She remained on the Board to become President.
The VCNP Bylaws made provision for redistribution of members, to facilitate participation of LNP’s in all parts of the state. This change created the possibility of adding regional groups.
The database for VCNP membership was completed after redistricting the regional groups and contracting administrative services.
Three new regional groups formed – Shenandoah, Northern Shenandoah, and Blue Ridge.
VCNP’s website came on line in May.
VCNP Bylaws were updated and modernized, the first major change in many years.
Fredericksburg became the newest VCNP regional group.
The law had expanded prescriptive authority to include all drugs except those with the greatest potential for abuse. This was to be accomplished by 2003.
VCNP concerns included: How to increase VCNP’s membership, develop other sources of income besides the VCNP Conference, maintain the necessary level of legislative work and involvement, continue the administrative services which had become essential, and maintain forward momentum.
A new category of NP was recognized, the Psychiatric Mental Health Practitioner.
The newly formed Peninsula Regional Group increased the number of VCNP Regional Groups to 11.
The Board of Nursing adopted final regulations on continued competency requirements for licensing and for prescriptive authority.
Legislation passed authorizing NP’s to refer directly to physical therapists.
In July, Schedule III drugs were added, so that prescriptive authority included Schedules III – VI.
2004 – 30th Anniversary of the VCNP
The Distinguished Nurse Practitioner Award and the Educational Award were given by the VCNP for the first time.
The practice doctorate for NPs entered VCNP discussion.
Legislative issues continued to be important, needing the persistent surveillance and active participation on the part of the VCNP. These included: PCP status, reimbursement, supervision, protocols, prescriptive authority, supply of NP’s, hospital scope of practice, malpractice, and Provider Neutrality Legislation.
The Founders Award was presented by the VCNP for the first time.
Administrative support by Ruggles was associated with increase in services, notably expanded electronic communication for the VCNP membership and Board members.
The Public Relations Committee was formed.
Schedule II drugs were added to the prescriptive authority for VA NPs, effective July 1.
Retirees were beginning to be seen as a new group of members, emerging at a rapid rate.
Reimbursement Task Force was rejuvenated.
Electronic communication had increased. Examples include: publication of a newsletter resumed on a quarterly basis; a variety of information about the VCNP, such as how it serves its members and works to improve health care; its Annual Conference; and voting online.
Strong use of the website by membership had been demonstrated. There was first time online registration and evaluation of the Annual Conference, and the syllabus for its educational program was presented on a CD-ROM.
2009 – 35th Anniversary of the VCNP
The VCNP at 35 – Signs of Growth and Progress
The number of LNPs in VA has increased in the past 10 years, from 3,804, with 1,571 having prescriptive authority in 1999, to 5,524 LNPs with 3,203 having prescriptive authority in 2009.
In 1983, when the organization was still the VA NPPPG, a directory done by the PPG included 450 NPs listed on a voluntary basis.
In March of 2004, there were 1,294 VCNP members. Five years later, 1,556 were listed, with 23 being retired and having become the fastest growing group within the membership.
There were 5 VCNP Regional groups in 1982. Six more have been added since that time.
The first NP program in Virginia was begun in 1971 at the University of Virginia, The recent addition of James Madison University’s program brought the number to 9. In the early years there were certificate programs which did not require an academic degree. In 2009, programs leading to a doctoral degree have been rapidly increasing, nationally and in Virginia.
The size and complexity of the VCNP have increased. The VNA – NPPPG Officers and Job Descriptions, which functioned as bylaws in 1981, was 1 page in length. There were 3 positions: Chair, Chair – elect, and Secretary, and only 2 committees, Program and Nominating. Affiliated groups (regional groups) were provided for under the VNA Bylaws and the Chairmen group existed according to the General Rules of PPG’s (3 pages Long + 1″ on page 4), revision date 1978.
Change from PPG to the Council status occurred in 1984, to be supported by a 4 page Bylaws document in 1986. Officers included Chair, Chair – elect, Corresponding Secretary, and Recording Secretary – Treasurer. The last job would seem to have been heavy duty, but Pat Newton served in that role for 10 years. The Treasurer’s report, dated 7-12-86, indicated a balance of $377.59, which had been $450.16 three months previously. These amounts pale compared to present VCNP accounts. Chairs of the regional groups and of the standing committees were included. The transition from Mid-Atlantic Nurse Practitioner Conference, which had been the work of the Richmond Regional Group, took a few years to transition to the present way of functioning under the VCNP’s Conference Committee, which presents the VCNP Conference annually providing education units.
Current Bylaws in contrast expanded to 13 pages in length plus the policies. Four members of the Executive Committee became 5. The Board expanded to 10 Standing Committee Chairs, and the Chairs of 11 Regional Groups. The Legislative Committee, created around 1990, became the Government Relations Committee. Much energy and other resources have gone into supporting the work of this committee, resulting in many changes over the years for NP practice enabling NPs to have more positive influence on the provision of health care for Virginians.
Since the early years, when one of our members was formally accused of practicing medicine by a physician, there have been many changes. Scope of practice has evolved. Practice locations are no longer limited to geographic areas where there are not enough MDs, and in fact, are quite varied. In 1989, it was reported that the demand for NPs exceeded the supply!
Considerable resources of the VCNP have been directed into the improvement of health care for Virginians through legislative involvement, providing educational opportunities, and increasingly engaging in community activities and service. Supporting the response to programs for Katrina victims in 2005 is only one example.
The VCNP has been the organization representing and serving the increasing numbers of NPs in the state. It has spent a great amount of its resources – time, energy, and money – to remain vibrant, relevant, and abreast of changes as health care knowledge has progressed, and as health care system needs have changed. The VCNP has been the organization to support such achievements by investing its collective resources in professional and legislative organizations, providing educational opportunities, and maintaining communication with NPs in the 11 regions throughout the state.
Dorsey, Corinne F. A History of the Virginia Board of Nursing 1903-2003.
Dorsey, Corinne F. History of the Regulation of Nurse Practitioners in Virginia, September, 1995.
Histories of the Richmond and Tidewater Regional Groups of the VCNP
Special Joint History Committee of the Virginia Nurses Association and the Virginia League of Nursing. Highlights of Nursing in Virginia, 1900 – 2000, May 2001.
VCNP Minutes 1985 – 2008.