HD18 - Report on Advanced Practice Registered Nurses (Chapter 552, Item 309.C., 2021)

Executive Summary:

This Report is in response to a request in the 2021 Special Session I Virginia General Assembly Budget Bill, which reads, “The Department of Health Professions (DHP) shall study and make recommendations regarding the oversight and regulation of advanced practice registered nurses (APRNs). The department shall review recommendations of the National Council of State Boards of Nursing, analyze the oversight and regulations governing the practice of APRNs in other states, and review research on the impact of statutes and regulations on practice and patient outcomes. The department shall report its findings to the Governor and General Assembly by November 1, 2021."

Regulation of APRNs varies significantly from state to state. In 2008, the National Council of State Boards of Nursing developed the Consensus Model for APRN regulation, which presents recommendations for state legislatures and boards regarding the regulatory structure for APRNs (Certified Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists and Certified Registered Nurse Anesthetists).

Virginia has been moving towards alignment with the APRN Consensus Model but differs in two significant ways:

1) Virginia does not grant all APRNs the ability to practice independently; and

2) Virginia does not regulate APRNs solely through the Board of Nursing. DHP found a number of recent studies responsive to the impact of regulation on practice and patient outcomes. These studies indicate that granting APRNs independent practice authority may increase APRN supply without reducing quality of care.

Recommendations from DHP are to:

1) Amend statutory and regulatory definitions to conform to those in the APRN Consensus Model;

2) Consider amending Virginia laws and regulations to align with the APRN Consensus Model; and

3) Pursue participation in the APRN Licensure Compact.