Nurse practitioners; practice without a practice agreement. (SB5070)

Introduced By

Sen. Jen Kiggans (R-Virginia Beach) with support from co-patron Del. Dawn Adams (D-Richmond)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Nurse practitioners; practice without a practice agreement. Reduces the number of years of full-time clinical experience a nurse practitioner must have to be eligible to practice without a written or electronic practice agreement from five years to two years. Read the Bill »


Bill Has Failed


08/17/2020Prefiled and ordered printed; offered 08/18/20 20200713D
08/17/2020Referred to Committee on Education and Health
08/19/2020Passed by indefinitely in Education and Health (11-Y 4-N) (see vote tally)


Maria Paone writes:

Virgins is one of the safest states for patients right now. It would be a terrible mistake to remove the five year requirement for NPs. Of a physician needs a minimum of four years of school and 3 years of residency to practice independently, a nurse should have more requirements, not less.

NP schools no longer require years of nursing experience for entry. Many programs are 100% online. These graduates have no place ever being independent practitioners. NPs need more oversight, not less. Physicians who supervise them need to be held to might higher standards. This is a matter of safely. Do not give in to the nursing lobby. Lives are at stake.

Carrie Gould writes:

Our veterans deserve the best, after all that they have sacrificed for our country. The best is physician-lead healthcare. Midlevels and physician extenders were never meant to replace physicians, but to work with them, with close oversight, and their training (which has not increased in scope or rigor) was reflective of that role. If anything, their training has gotten less rigorous with easier entry and less oversight. Physicians undergo tens of thousands of hours of training before being independent. They work closely in a hierarchy with several levels of attending and supervisory physicians teaching them. Physicians pass extensive board exams to prove their knowledge. Medical education is standardized as well with examinations at each level before continuing. Until non-physician providers undergo the equivalent education and training, they should not be considered interchangeable. Unlike the private market, our veterans have no choice in their healthcare providers, which makes this being imposed upon them even sadder. Both my grandfathers were wonderful men who served in wars for our country. If they were alive today, it would make me fearful for their safety.

Maria writes:

I am a physician and I have corrected that have suffered from the mismanagement of poorly trained personnel including RNs which graduate from programs with little oversight and limited training. Despite being a board certified physician I am a patient first and foremost and this deeply concerns me.

Deborah Fletcher writes:

Hello, this is an unsafe plan. Less education and training does not make one better able to practice medicine unsupervised. The non-physician NP was never intended to take the place of the physician, but to help and support them. The independent practice of NPs was never intended, as they should be working with a physician led team. They can be a valuable part of the medical staff, but do not have the training and oversight to know what to do as much as a physician does. The NP lobby is strong and will convince you that it is fine, but it is not. Studies have proven a markedly higher rate of opioid prescribing, inappropriate antibiotic use, and specialty consultations, which can actually increase the cost of medical care. The idea that they are going to help the rural areas is false - the numbers prove that only smaller group actually does this - they stay in more urban areas instead. When your family member is significantly ill or has a complicated diagnosis, you want the best educated person to care for them.

Erik Eklund writes:

It is irresponsible to reduce supervision time for midlevels as they are already grossly undertrained relative to physicians. They are unaware of their own clinical deficits, and reducing what little training they have in the name of profit saving (that has no demonstrable effect on rural access to healthcare) will simply lead to more patients being treated in a suboptimal manner.

Bill Mark writes:

The people responsible for passing these types of bills should be relegated to seeing only Midlevels for their own personal care. I say put your money where your mouth is. If you feel that Midlevels are sufficiently trained enough to provide for strangers, then it should be sufficient enough for you as well.

I think we all know that this is not the case. This is not what patients would agree to if properly informed. This is about money and nothing else.

Jeff writes:

NPs are scam artists with not even comparable training to practice independently. This bill just states that it is okay for patients to receive poor care and die.

Caroline Halverstam writes:

Our veterans deserve top notch healthcare for the sacrifices they’ve made to our country!

NPs are valuable members of the team, but do not receive the same intensive training in diagnosis and management that physicians receive. They are well trained to follow a management plan determined by a physician after a physician makes a diagnosis. But they should not be making these decisions without physician supervision.

I hope our veterans’ health is not sacrificed in order to save a few bucks.

James writes:

Nurse Practitioners already hold a valuable role in our healthcare system that is appropriate for their level of training. Patients deserve only the best from their care teams, and physician-led healthcare is the safest and most effective route. NP's are trained in nursing, not medicine, and to allow them to practice medicine outside of their scope of training is a worrying prospect. Please don't compromise the quality of care for millions of patients in the name of financial savings. Peoples' lives are at stake.

Rose Roberts writes:

Nurse Practitioners provide useful services but are trained in nursing, not medicine. They do not learn the same academic or patient-based content compared to physicians, nor are their testing requirements as rigorous. By changing the law to a 2-year supervisory period NPs would also be able to graduate from a program and practice independently before medical students even graduate from medical school, much less complete their residency.

There is increasing evidence that independently practicing NPs provide a lower quality of medical care for their patients than supervised NPs or doctors of medicine. This retrospective study states NPs in unsupervised states are 20 times more likely to overprescribe opiods than those in restricted states. This is the opposite of what we're trying to achieve in ending the opiod crisis.

An additional retrospective study states that NPs are more likely to prescribe antibiotics, including in situations where antibiotics should not be the first line of action.

Nurse Practitioners are a key component to our healthcare system, particularly in rural communities where it may be difficult to access a plethora of healthcare options or in 24/7 urgent care in urban and suburban areas. However they do not have the academic scope nor length of training necessary to appropriately respond to and treat patient needs unsupervised.

William Derrick writes:

This is a terrible idea. Nurse Practitioners are invaluable parts of a healthcare team but they will never be an appropriate replacement for a physician taught in medical school and put through residency. Their training is not equivalent in quality, content, or years. If they wish to work unsupervised, let them go through the same hurdles as a physician. We cannot lower the expectations of an independently practicing professional at the expense of patient healthcare and wellbeing.

J Ross writes:

Midlevel providers receive less training than physicians. If anything, their requirements should be Increased, not decreased. To shorten time would show blantant disregard for patient wellbeing and basic common sense.

Anand H Upadhyaya writes:

Patients deserve physician-led care!