By Judy Collins, RN, MS, WHNP-BC, FAAN and Diane Hanna, RN, MS, FNP-BC
- Statewide Council on Infant Mortality (VCIM) – Request made by Council to Eva Teig, Secretary of Health and Human Resources (HHR) to study the barriers to practice for nurse practitioners (NP) in Virginia related to access to care for women during pregnancy and infant care. Judy Collins was a member of the VCIM.
April 10, 1989
- Memorandum sent to Corrine Dorsey, Dr. Elenora Daniel, and Dr. Clementine Pollok, Board of Nursing (BON) and Jan Johnson, Virginia Nurses Association (VNA) with draft letter to Secretary Teig with overview of NP issues and an annotated bibliography for review to request a study of NP practice. (Written by Diane Hanna and Judy Collins)
- Judy Collins discussed Barriers to Practice Study with Bernie Henderson, Director, Department of Health Professions (DHP) and Debbie Oswalt, Deputy Secretary, HHR. They recommended study by DHP as opposed to Study Resolution by the General Assembly.
April 20, 1989
- Letter sent to Secretary Teig outlining request for study including overview of issues and supporting documents. Letter stated “study of NP’s with special emphasis on barriers to practice and access to services will be supportive of your statewide efforts to identify and solve problems related to primary health care for all Virginians.”
(Kept issue focused on health care vs. self serving for NPs.)
- Secretary Teig requested the DHP and Board of Health Professions (BHP) to “study barriers to the optimal use of nurse practitioners in the Commonwealth”. The study was prompted by “concerns for health access, cost and quality and directed toward the identification of structural and attitudinal barriers that could limit the full knowledge and skills and competencies of nurse practitioners.”
June 13, 1989
- Press Release from Bernie Henderson, Director, DHP vowed to “spare no sacred cows” in studying ways to improve health care for needy citizens by expanding the role of nurse practitioners. Henderson told the VCIM that requested the study, “There are many different kinds of barriers that prevent NPs from providing their full measure of safe, cost-effective, quality health care services to the people of Virginia.” Henderson stated these barriers to practice have a “disproportionate adverse impact on the on the most fragile components of society-the unemployed, the elderly, the homeless, the uninsured and the under-insured.” He further stated, “We will be looking for and eventually advocating proper and bold changes in law, regulation, policy and attitudes-not compromises to mollify a long line of special interests.” Dr. Barbara W. Altizer a sociologist and member of the Board of Health Professions was appointed chair of the study.
July 12, 1989
- Study of Access and Barriers to the Services of NPs in Virginia initiated by DHP and BHP. An overview of the study and identification of the components were outlined with a plan for a report with recommendations to the Governor, the Secretary of HHR, DHP, and the General Assembly by December 1, 1989.
- The barriers to address included:
- Lack of prescriptive authority
- Resistance to direct third party reimbursement, and limitations on coverage and payment for preventive care
- Difficulty in obtaining hospital privileges
- Resistance to attempts to develop collaborative relationships with physicians
- Potential destabilization in the availability of malpractice insurance
- The Task Force Members included, nurses, physicians, hospital administrator, pharmacist, consumer, and nurse practitioner (Judy Collins)
August 1, 1989
- Public Hearing on the Practice of Nurse Practitioners held from 10 a.m. – 2 p.m. in the General Assembly Building. Terry Tempkin, Chair, VCNP sent notice to all VCNP regions/members to attend the hearing and urged members and supportive physicians, administrators, consumers, to come and testify. Guidelines for Giving Public Testimony with an example were sent with the mailing.
(The Tidewater Regional Group underwrote the cost of the mailing-pre e-mail and fax era!!!)
- Approximately 50 people spoke or sent written testimony to be considered including, nurses, nurse practitioners, nurse midwives, nurse anesthetists, physicians, administrators, etc. Comments ranged from very positive to very negative about NPs-including, NPs give “substandard care”, MDs can “solve all problems” and an announcement that the Medical Society of Virginia had formed a “special committee to address issues of NPs”. Terry Tempkin took handwritten notes on content from each speaker!!!
- One speaker “blasted” Bernie Henderson, Director, DHP for his press release content. In an intense exchange, Mr. Henderson said they (physicians) had “worked behind his back” and he staunchly defended his panel and the study.
- The Task Force met throughout the Fall, 1989 to study all barriers to practice and received invited presentations from NPs, physicians, and organizations. The Interim Report noted “Of all issues considered, the question of whether NPs should have limited authority to prescribe medications has the most significance for public policy. Lack of limited prescriptive authority for nurse practitioners is the most exhaustively documented barrier to the use of nurse practitioners in providing safe, cost-effective health care to all sectors of Virginia society. It is also the most controversial of all questions considered by the Task Force.”