Dear Boards of Medicine and Nursing,

I respectfully request that the Joint Boards consider that the General Assembly overwhelmingly approved the fundamental concepts of nurse practitioner (NP) transition to practice with the five-year post-licensure compromise. Any obstacles that limit these fundamental concepts should be minimized as they would not be consistent with the spirit of the legislation and bipartisan will of General Assembly.

The NP community acknowledges that the five-year post-licensure transition to practice requirement resulted from political compromise and is not based on any evidence. NPs are prepared at the graduate level and are deemed competent clinicians upon graduation and passage of national certification. Policy development without supporting evidence, results in variability as evidenced by the significant inconsistency between the transition to practice time requirements from state to state. Virginia is the outlier among all other states in the nation and as such will be in the spotlight as regulations are being promulgated.

It is requested that the Joint Boards bear in mind that NPs have unique skills and expertise that are complimentary to the physician and other team members on the patient care team. It is therefore not reasonable to expect that there would be an absolute overlay of the physician's area of practice and the NPs licensure and certification. We work in many settings with MDs, DOs and DPMs to illustrate this point. A broad interpretation of basic internal medicine education of any specialist physician must be considered sufficient to meet the requirement for practice in a patient population and practice area that the NP is licensed and certified.    

The board must consider the portability of professionals and that an NPs may have had several collaborating physicians during the required 5-year transition period. Therefore, the attestation needs to accommodate the names of several physicians and/or other evidence from entities such as practice administrators, employers, or credentialing documents, etc. based on individual circumstances. It is suggested that the boards consider formatting the attestation in a check list format for physicians to check the requirements specified in the law.  

For example:

• physician has served with the NP pursuant on a practice agreement
• physician routinely practiced with a patient population and practice area for which the NP is certified and licensed
• physician practiced with NP from ____________date to ___________date

It is also suggested that the boards consider that NPs in any state or working for U.S. Armed Forces, U.S. Veterans Administration or the Public Health Service be able to submit evidence of the five-year equivalent post-licensure practice requirement with signature from an employer, a physician, a practice administrator, etc. when coming from another state to practice in Virginia. This will prevent bottlenecks to building the necessary provider workforce and equitable distribution in primary care delivery for underserved and vulnerable populations.

Thank you for considering my comments for promulgation of regulations for NPs in Virginia.

Respectfully,

Cynthia M. Fagan, MSN, RN, FNP-BC