Nurse Practitioners Facing Change in Oregon, Virginia

January 9th, 2012

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By , BSN, RN

Nurse practitioners (NPs) and NP students are facing challenges on both coasts this month. Out west, in Oregon, the state board of nursing is recommending a major nursing education program stop enrolling NP students following an investigation by a board review team that found some online courses and instructors wanting. Meanwhile, back east, in Virginia, NPs are trying to make changes to state laws that govern practice.

These changes and reviews come as around the country there is a greater demand to address healthcare workforce shortages, especially in rural areas. A 2010 report from the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF), The Future of Nursing, has called for expanded roles for NPs and for master's level NPs to earn their doctorates. That, combined with a 2004 American Association of Colleges of Nursing (AACN)recommendation that all nurses seeking to work as NPs earn a doctorate of nursing practice (DNP) makes these issues currently on the table all the more important.

Is Online Nursing Education Subpar?

In a story published in Friday's Oregonian, preliminary recommendations from the Oregon State Board of Nursing are that Oregon Health & Science University School of Nursing (OHSU SON) should stop enrolling advanced-degree nursing students in some traditional and online classes until problems with the quality of instruction are corrected. OHSU's nursing school provides education to a large portion of the state's nurses and is often ranked among the country's top nursing education institutions.

Reviewers met with students, faculty and administration as part of a scheduled three-day visit in December. They were following up on complaints made earlier in 2011 by staff and faculty. The review team's report described a culture of denial and lack of accountability and said the school officials tolerated subpar quality in the online learning coursework. The teams other findings included:

  • Repeated state warnings that a pharmacology instructor was not qualified and was "creating a public safety risk" were ignored.
  • Faculty and administration seemed unaware of "extreme dissatisfaction" among some students.

OHSU provost and vice president for academic affairs, Jeanette Mladenovic, says the school will halt new admissions in some of their graduate level online courses to ensure quality, and they will reduce admissions to the family nurse practitioner program until new senior faculty are hired.

Teamwork Not Independence for NPs

Nurse practitioners in Virginia have been lobbying for autonomy in practice for more than two years in Virginia. Currently the law requires that doctors supervise and direct NPs—and the Medical Society of Virginia like it that way. Until very recently physicians there had resisted any changes to the law.

However, a compromise has been found and now NPs and physicians are working together to get the state law changed.

The proposed changes would require NPs to work in teams led by physicians. It may not sound like much of a difference but it should allow for more flexibility in coordinating patient care, better access to healthcare in areas where there is a need, and the bill being written would allow for electronic collaboration.

Besides the call for more NPs and more education, the 2010 IOM report called for states, including Virginia, "eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their education, training and competence."

Cindy Fagan, president of the Virginia Council of Nurse Practitioners, said, the compromise was an incremental step but that NPs would continue to work towards independent practice. "We think removal of physician supervision is a significant step forward," she said. "We think we're moving in the right direction, and we're hoping that continued dialogue will continue to remove barriers in the years to come."

Nurse practitioners are authorized to diagnose illnesses, prescribe drugs and often run their own clinical practices in conjunction with some kind of physician cooperation or supervision. The NP education comes in two levels: a master's degree as a nurse practitioner or a DNP. The AACN has said that, "Bringing more nurses into master and doctoral nursing programs must be a priority given the critical need for nurses to serve as scientists, faculty, primary care providers, specialists, and leaders within the healthcare system.”

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