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DNP Discussions

DNPs & the Legislative Process

Published February 17, 2016 10:19 AM by Rebecca Bates
As we move through the legislative session in Virginia, I am reminded that there are multiple sides to each issue. As an APRN, I have worked in "green" states with full practice authority (FPA) and "red" states with restrictive practice regulations. The uphill battle to gain FPA in Virginia is constantly blocked by the Medical Society of Virginia and other groups who perceive the push for FPA as a threat to their income and turf. 

As NPs and DNPs in particular, we need to understand and help our colleagues and supporters to understand the legislative language. Current bills under consideration in our General Assembly address NPs practicing outside of a physician-led patient care team in specific settings. These settings include medically underserved areas or locations that suffer from 1.5 times the state unemployment rate. However, after subcommittee discussion, some of these bills received "substitutes" that removed the original language and substituted completely different language.

Amazingly, the same arguments that have been circulated for years by APRN opposition groups, have been re-circulated again this year: education is not as rigorous as physician education, NPs will not move to practice in rural and underserved areas if practicing in a FPA state, NPs are unsafe practitioners, NPs have worse outcomes, etc. Each of these claims has been debunked through rigorous research and decades of practice data and outcomes. 

Interestingly, in December 2015 and January 2016, there were two new studies published by Montana State University. One specifically addresses NP cost for caring for Medicare patients versus physician cost. The second specifically addresses NPs moving to rural practice in states with full practice authority. As DNPs, we need to help lead the movement to move all states into FPA by continuing to review the literature for additional supporting evidence and to counteract the loud voice of our opposition.

As DNPs, we need to be well versed in the arguments against FPA for APRNs and against the IOM recommendation to allow all nurses to practice to the full extent of their education and training. These restrictive practice environments are not only found in Federal and State regulations, but in our hospital and outpatient practices as well. In order to be an effective advocate for ourselves, our patients, and our profession, we need to be aware of and understand both sides of the argument.

I challenge you to become an advocate. Learn the legislative process and take an active role in health policy. 


Well Stated. After speaking with several colleagues here in Georgia, I realize there is a lot of ignorance concerning the attack on our liberties to practice to our full scope of care here in Georgia as well. The MAG (Medical Assoc. of Georgia) spends millions of dollars trying to undermine the NP role in healthcare and we know nothing about it. Please get involved.

Kym Mwansa, DNP February 29, 2016 11:11 PM
Roswell GA

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