HD23 - Report on the Practice Locations and Schedules of Drugs Authorized for Nurse Practitioners with Prescriptive Authority


Executive Summary:
Introduction:

House Joint Resolution 205, adopted by the 2004 General Assembly, requested that the Board of Nursing collect information on nurse practitioner prescriptive authority. Specifically, the Board was asked to collect information regarding the (i) practice locations of nurse practitioners and (ii) number of nurse practitioners with the authority to prescribe each Schedule of controlled substances and devices. An executive summary and the information collected was to be submitted no later than October 1, 2004 to the Joint Commission on Health Care, the Senate Committee on Education and Health, and the House Committee on Health, Welfare and Institutions.

Background:

In Virginia, nurse practitioners are jointly licensed by the Boards of Medicine and Nursing in several categories of specialty practice, including nurse anesthetists and nurse midwives. Licensed nurse practitioners, with the exception of nurse anesthetists, are eligible to prescribe controlled substances, if they meet certain educational criteria, have a written practice agreement with a supervising physician for prescriptive authority and have obtained an additional license for prescriptive authority. Since July 1, 2003, nurse practitioners with prescriptive authority have been authorized by law to prescribe Schedules III through VI. Though legally authorized to prescribe scheduled drugs (with the exception of Schedule II), nurse practitioners must have a written agreement with the supervising physician that specifies which schedules they are permitted to prescribe in their particular practices.

In its study of access to primary care in Virginia, the Joint Commission on Health Care found that information was not available on where nurse practitioners are practicing and on what schedules of controlled substances they can prescribe. Therefore, House Joint Resolution 205 was introduced to request the Board to collect such data and report to the 2005 General Assembly.

In order to collect information on practice locations and the schedules of controlled substances nurse practitioners are authorized to prescribe, the Board sent a survey to all nurse practitioners with prescriptive authority. Those who did not respond to the initial request were sent a follow-up survey and letter. In addition, the Virginia Council of Nurse Practitioners was asked to publicize the survey and urge its members to cooperate in providing information.

Results of Survey:

There are 4,899 persons who hold a Virginia license as a nurse practitioner. Approximately 1,530 of those are certified registered nurse anesthetists (CRNA's), who are not authorized to prescribe. Of the 2,538 who have obtained prescriptive authority, the Board received a 70% response rate with 1,764 surveys returned and entered in a data base.

Practice locations: Nurse practitioners were asked to identify their primary practice location by address and zip code. The responses were then grouped by the three-digit prefix of each zip code into 16 regions of the state. Based on the 70% survey response, the Board was able to project the number of nurse practitioners in each of the 16 regions and out-of-state locations to account for the total of 2,538 persons licensed in Virginia and to arrive at a ratio of licensees per population.

By comparing the total population listed for the zip codes in each of the regions with the number of nurse practitioners who identified the primary practice address within those zip codes, we were able to establish an average ratio of nurse practitioners with prescriptive authority to the population. Statewide, the average was one nurse practitioner to 2,789 people. The highest concentration of nurse practitioners was in the Charlottesville area with a ratio of 1:1,232, followed by the Richmond area with a ratio of 1:2,388. Both areas include major medical centers where a large number of nurse practitioners are employed. Other areas of the state with a better than average ratio included Culpeper at 1:2,515 and Bristol at 1:2,495.

Other areas had a higher than average ratio of population to nurse practitioner, but not significantly so. For example, in the Grundy district, the ratio was 1:3,026, compared with the state average of 1:2,789. In Northern Virginia, the ratio was 1:2,930, and in the Norfolk area, the ratio was 1:3,083 - similar to the ratio in Wytheville at 1:3,040. The region with the highest ratio of population to each nurse practitioner was Petersburg with 1:6,008.

Schedules of controlled substances authorized to prescribe: On the survey, nurse practitioners were asked to check those schedules of drugs that they were authorized in their practice agreements to prescribe. Of those responding, the largest number indicated authority to prescribe all schedules authorized by the Code of Virginia - Schedules III through VI (844 of the 1,764). Of the remaining number, 350 only prescribe Schedule VI (which includes the majority of prescribed medications - such as antibiotic, anti-inflammatory, and anti-allergy); 242 listed Schedules IV through VI (some noted that they had applied to the Drug Enforcement Administration for approval to also prescribe Schedule III); 168 listed Schedules V and VI. There were 23 persons who commented that they had current prescriptive authority but are not currently working, and 53 who did not fall into any of the categories listed. Among that final group, there were some who are working but not currently prescribing, others who listed only one schedule (other than Schedule VI), others who listed a combination of schedules differently from the manner in which the information was sorted, and some who failed to complete that portion of the survey.

Continuation of data collection: Since the collection of data on practice locations and schedules of controlled substances for the purpose of responding to HJR 205, the Board of Nursing has revised the practice agreement to request that information of all applicants for initial authorization and resubmission of agreements following a change in employment or in physician supervision. Data collected on practice locations and schedules of controlled substances authorized to prescribe will be maintained in an electronic format and will be accessible for on-going review.

Attached are the chart of data collected pursuant to HJR 205 and a graph of the distribution of nurse practitioners with prescriptive authority in Virginia.