Lawmakers hear nursing, physician debate over scope of practice

(State Journal) As major changes to the country’s health care system approach, nearly everybody in the health care field is trying to brace for the impact.

Toni DiChiacchio, a family nurse practitioner who owns Health Thru Care LLC in Morgantown, spoke to lawmakers Sept. 11 about the need for nurse practitioners to have more power to see patients autonomously.

The state’s performance evaluation review division would have to be the entity that would change the state’s policy on scope of practice.

DiChiacchio said she spoke with the chief executive officer of Mon General Hospital while creating her own business plan and saw the problems the area has with primary care. She said 40 percent of all patients admitted to Mon General Hospital do not have primary care providers.

“I can’t even imagine what it’s like in the rest of West Virginia that’s rural and underserved,” DiChiacchio said.

DiChiacchio told lawmakers that neighboring Maryland is one of more than a dozen states that allows nurse practitioners to practice entirely autonomously, and while liability is a big hurdle to the process, she said 40 years of research has shown that no more harm is caused to patients seen by nurse practitioners than patients treated by physicians.

“Patients likely will continue to see physicians, but it would be nice for them to have another choice,” she said.

Dr. Hoyt Burdick, president of the West Virginia Medical Association, told lawmakers it would be a step in the wrong direction. Burdick said health care is focused on cooperation and teamwork.

“Even residencies are focused on collaboration and systems, so there’s a move toward team-based care,” Burdick said. “The movement for nurses to treat patients without doctors on their team comes at a time when medical care is shifting toward a team-based approach.”

Burdick said for health care to work in the 21st century, the power of a team has to be leveraged.

“Eliminating collaborative practice agreements promotes further isolated individuals in a fragmented system,” he said.

The Legislature re-wrote the definition of a nurse practitioner in the state and also expanded prescription rules in the most recent legislative session so nurse practitioners could prescribe drugs for chronic conditions. Burdick said his organization worked collaboratively with other groups to develop the list of chronic conditions.

DiChiacchio stressed to lawmakers that she agrees with Burdick, that nurse practitioners need to collaborate, but if nurses could play a bigger part in health care, it could help physicians dig into their knowledge and experience that she said often is “under-utilized.”