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Lawmakers asked to let nurses prescribe

CHARLESTON, W.Va. — West Virginia’s Advanced Practice Registered Nurses want more autonomy and the ability to write prescriptions without a doctor’s approval.

The nurses have been lobbying for changes in state code for more than two years, and lawmakers say they are determined to bring those requests before the Legislature this coming session.

Wednesday’s meeting of the Joint Standing Committee on Government Organization Sub-Committee A marked the second day of discussions on the issue, with reports and information presented Monday before the committee.

Beth Baldwin with the West Virginia Nurses Association Advanced Practice Congress said removing restrictions and requirements, specifically those requiring collaborative agreements with doctors and severely limiting the ability of advanced practice nurses to write prescriptions, would improve healthcare in West Virginia.

“Twenty to 30 years ago it would have been unthinkable to limit a patient’s care,” and options, she said. However, “the laws of West Virginia remain stagnant.”

Among the most troubling restrictions, Baldwin said, are requirements for advanced practice nurses to have collaborative agreements with doctors to write prescriptions. The nurses can write some prescriptions, but only for a limited time.

Baldwin said these limitations cause patients stress and limit their access to necessary medications. It also places advanced practice nurses in a position where their practices are directly linked to doctors and can be disrupted through no fault of their own should something happen to the doctor or the doctor’s license.

Under existing state law, nurses also must rely on doctors to sign common medical forms, such as End Of Life documents for funeral homes, which can force them and patients to wait days or even months to secure a physician’s signature.

Baldwin said 19 states, including all states bordering West Virginia, and Washington, D.C., have done away with such requirements for advanced practice nurses and grant them full prescription authority. Baldwin said if the restrictions do not change, West Virginia will see more advanced practice nurses leaving the state and a shortage of primary care providers as the physicians continue to age and retire.

The Sunrise Report by the West Virginia Legislative Auditor’s Office Performance Evaluation and Research Division expressed concerns over ending the required collaborative agreements, which the report said “provide an important level of patient protection.”

Officials with the division also warned of possible abuse if a large number of nurses were suddenly able to write prescriptions for narcotics with little or no direct supervision.

The nurses association has disputed the report’s conclusions.

Legislators also have expressed concerns that advanced practice nurses could replace primary-care physicians in some areas of the state, but potentially could have less education and experience.

Baldwin said nurses have been lobbying for the changes for more than two years now. Committee co-chairman Sen. Herb Snyder, D-Jefferson, said legislators have received numerous reports and mountains of data on the topic, and he apologized for the delay in getting a bill before the Legislature.

“I am charged with finding a compromise in this, and I’m confident we can find one,” Snyder said. “I am serious about having a resolution on this.”

Representatives of doctors and the West Board of Medicine will speak to the committee next month.

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