House Bill 793 (2018)(*1) permitted Licensed Nurse Practitioners, excluding certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists, to practice without a practice agreement upon submission of proof of completion of the equivalent of five years of full-time clinical experience (hereafter referred to as Autonomous LNP). This Report is provided to the Virginia General Assembly pursuant to the HB 793 Enactment Clause.

The study period of this Report is February 6, 2019 through June 30, 2021. Of the 1,257 Autonomous LNPs identified, approximately 90% reported primary care and psych/mental health specialties. The geographic distribution of Autonomous NPs is presented by County both in composite and per 1,000 residents. The per capita data (see page 3) suggests that Autonomous NPs provide at least some care in the more underserved areas of the Commonwealth, including the Eastern Shore, Southwest, Northern Neck, Southside, and Shenandoah Valley.

The complaint rate of both Autonomous NPs and physicians is higher compared to other professions regulated by the Department of Health Professions, but the violation rate is lower. The five (5) Autonomous LNP cases involved the inability to safely practice; drug-related, patient care, and criminal activity. These are similar case categories to other nursing and medicine cases.

Finally, the recommendations identified and discussed (but not voted on) by the Committee of the Joint Boards of Nursing and Medicine at its meeting on June 16 were compiled by DHP staff into an initial draft of this Report, which was then provided to the Boards of Nursing and Medicine for consideration at each board’s subsequent business meeting.

At its meeting on July 20, 2021, the Board of Nursing approved the Report as written (see page 5). The Executive Committee of the Board of Medicine, at its meeting on August 6, 2021, accepted some but not all of the recommended modification of the Act (see table on page 6).

The key differences between the Board of Nursing and Board of Medicine recommendations are that the Board of Medicine supported continuing to require 5 years of collaboration with a physician before autonomous practice, while the BON supported requiring only 2 years of collaboration, with either a physician or experienced licensed nurse practitioner, or eliminating the practice agreement requirement entirely.
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(*1) See House Bill 793 for the legislative summary, text, and history of the bill.