Nurse practitioner; patient care team provider. (HB896)

Introduced By

Del. Dawn Adams (D-Richmond)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Nurse practitioner; patient care team provider. Eliminates the authority of a physician on a patient care team to require a nurse practitioner practicing as part of a patient care team to be covered by a professional liability insurance policy and the requirement that a nurse practitioner practicing without a practice agreement obtain and maintain coverage by or be named insured on a professional liability insurance policy. Read the Bill »


Bill Has Passed


01/12/2022Prefiled and ordered printed; offered 01/12/22 22101321D
01/12/2022Referred to Committee on Health, Welfare and Institutions
01/21/2022Assigned HWI sub: Subcommittee #1
01/21/2022Impact statement from DPB (HB896)
02/01/2022Subcommittee recommends reporting with substitute (9-Y 0-N)
02/07/2022House subcommittee amendments and substitutes offered
02/08/2022Reported from Health, Welfare and Institutions with substitute (22-Y 0-N) (see vote tally)
02/08/2022House committee, floor amendments and substitutes offered
02/08/2022Committee substitute printed 22105739D-H1
02/09/2022Impact statement from DPB (HB896H1)
02/10/2022Read first time
02/11/2022Read second time
02/11/2022Committee substitute agreed to 22105739D-H1
02/11/2022Engrossed by House - committee substitute HB896H1
02/14/2022Read third time and passed House BLOCK VOTE (99-Y 0-N)
02/14/2022VOTE: Block Vote Passage (99-Y 0-N) (see vote tally)
02/16/2022Constitutional reading dispensed
02/16/2022Referred to Committee on Education and Health
02/23/2022Assigned Education sub: Health Professions
02/24/2022Reported from Education and Health (13-Y 1-N) (see vote tally)
02/25/2022Constitutional reading dispensed (39-Y 0-N) (see vote tally)
02/28/2022Read third time
02/28/2022Passed Senate (38-Y 2-N) (see vote tally)
03/03/2022Bill text as passed House and Senate (HB896ER)
03/03/2022Signed by Speaker
03/04/2022Impact statement from DPB (HB896ER)
03/04/2022Signed by President
03/11/2022Enrolled Bill communicated to Governor on March 11, 2022
03/11/2022G Governor's Action Deadline 11:59 p.m., April 11, 2022
04/11/2022G Approved by Governor-Chapter 563 (effective 7/1/22)
04/11/2022G Acts of Assembly Chapter text (CHAP0563)


Ritu Madan writes:

Doctors go to medical school for 4 years and 3 years of patient management experience before they can completely evaluate patients and take treatment decisions . In my opinion- this training is not equal to 4 years of nursing school and 2 ys of NP course that is much less rigorous than MD training . There is no way NP can take complicate decisions after following a doctor just for 2 years. If you want Americans to get less than suboptimal Care, and take a step backward in healthcare, approve this bill .

Melissa Macaraeg writes:

Physicians are required to train for almost 80 hrs a week, on top of that do research and quality improvement. How is this right? NPs have a place in healthcare, but its not the same position as a physician. Do you want poorer outcomes? This is how you get poorer outcomes.

Neesa patel writes:

I ask every one, would you want a loved one, husband, wife, son, daughter, parents etc have the best in terms of who is taking care of them? If you would want a physician who has rigorous training to take care of your loved ones, why would it be ok for the rest of the public to be taken care of with less? It’s like flying a plane - would you be ok with a airline hostess who has a never landed a plane? Or would you want a seasoned pilot to land your plane? Enough is enough. We demand physician led care. Our life matters…

Katherine Percy writes:

It benefits no one to take away physician oversight except the hospitals making more money by not being required to pay for expert care. Why would a nurse practitioner not want a physician available to oversee critical cases? Why would a patient not want the person who trained specifically in that specialty for an additional 3-7 years overseeing their care? The consequences of losing the team model may be nothing for some, but catastrophic for others. As a physician who works with physician assistants hand in hand in the Emergency Department, I have seen how they expand our ability to see and help more patients at once, but also have seen there is a vast difference in the depth of knowledge and training, and without physician oversight more important things will get missed. Ask yourself what you would want for your own family. I would never let a solo non-physician care for mine, and you may be taking that option away from your constituents, family, and friends by approving this.

Cary Aungst writes:

Why exactly would a lesser trained nursing professional be able to practice on their own faster than their more rigorously trained physician counterpart can? And how is it looking out for the best interest of patients to eliminate nurse practitioners from a requirement to carry liability insurance? So when mistakes happen, because they can for any healthcare practitioner, there is no financial recourse for a damaged patient??

Brandon Faza writes:

Nurse practioners are advanced practice nurses; they do not practice Medicine. Physician-led medical care is the backbone of the American healthcare system for good reason; arduous, vigorous training matters. Removing the requirement for NPs without a practice oversight agreement to provide consultation services is a tacit agreement to remove physician oversight, or considerit unnecessary. NPs classicly order more imaging, testing, and consultations due to their lesser knowledge base and experience, particularly when predatory educational institutions have a 100% acceptance and 100% graduation rate, even for nurses with literally no bedside experience at all. They are simply not well-prepared for independent practice until much farther along in their careers, and absolutely need the oversight. The result of all the new suboptimally trained NPs ordering frequent unnecessary specialist consultations to the healthcare system is that now specialists are hiring NPs to handle all the unnecessary consults from NPs acting in primary care. This waters down healthcare and drives up costs. Without that physician oversight, the on-the-job training NPs absolutely need to avoid harming patients is foregone (because there are no universal requirements or good oversight on their educational programs). This bill is an absolutely terrible idea for the patients in this state, and a terrible precedent for patients across the country. Please vote NO on this bill.

Tristan Crowe writes:

Why are you entertaining a bill that gives a nurse more autonomy to practice “advanced nursing” with zero liability. How does that benefit patients? Patients should be cared for by someone who is medically trained and held to the highest standard. Anything less than that is dangerous and certainly not in the best interest of a patient? NPs are already held to a nursing not medical standard? They are not physicians and by removing supervision the intended role of an NP is changed. It’s changed to the role of a physician practicing medicine without the training or standard.
There are Online NP schools with 100% acceptance, no education standardization and the fraction of training required to reach the 4th year of medical school. This bill wants to reduce that training even more to allow independent practice?
What if your mom, dad, child, needed medical care? Are you going to feel comfortable that their is no physician? If there is medical malpractice you can’t sue a nurse for damages?

Annette writes:

Just a question: would you let a graduated medical student take care of patients independently? Graduating medical students have substantially more medical education than mid levels ever get. First, require midlevels to pass MCAT and step 1, 2 and 3, then this topic could be re-opened.
Also, Medical students volunteer hundreds of hours before medical school and go through two intense clinical years. Medicine is not following algorithms.
Take a very close look at the comparison of training and you will see that independent practice of midlevels is misguided and threatens patients’ health and life.

Slay writes:

Please consider the results of this bill. Ultimately you are allowing decreased education and responsibility for people to practice medicine when they actually have no training to do so.

This will learn to a class Delivery of healthcare where only the rich or the nearly killed by providers without any medical education/training/responsibility (NP/PA/DC/naturopathic) will be able to have access to medical care. Non physician providers were designed to extend not replace physicians. With this bill you will be replacing physicians.
Additional bills that require increased and prolonging physician training demonstrates that you are aware of the difference in roles but have not looked into rate of opiod prescribers or antibiotic, numbers of required consults which delays medical care or rate of polypharmacy and the prescribing-- not necessarily co-signing providers-- all of these occur at a greater frequency in an Non physician provider managed patient. Additionally, requiring medical doctors to carry increased financial responsibility will further deter physicians from considering practice in your state. Thus further limiting medical access. Studies show that increased NP autonomy does not increase rural access but does inflate cost of healthcare without equivalent health improvement (poor value)

To improve MEDICAL access, may I suggest creating a more physician friendly environment, one that supports them with the same-- or at least equal-- as not medically trained non physician providers.

May I also recommend that unless you and your entire family consistently get the decreased educational requirements and Dime a dozen and only worth their value "healthcare" providers such as a NP, it is hypocritical and irresponsible for you to force this on the people in your state. And perhaps you should consider how your loyalty has been purchased.

Michelle writes:

I work as an MD in independent practice state.
I can’t tell you how bad the training has become for many NP programs. No standardization and 100% acceptance. Many have never even been bedside nurses first. I am seeing things that any MD/DO would loose their licenses for not sometimes but quite often. They practice medicine regardless of what they say “top of license” and are not held accountable. You can not sue for malpractice. They are held to “nursing” standards in court of law. We report what we see but nursing boards seldom do anything and we fix the patients if we get them do no one understands how far things are falling. Health care standards in this country are declining so fast.

I am having more patients with cancer diagnoses missed (that were textbook presentations), diagnoses with dislocated bones that were normal X-rays, prescribed skin cream for high cholesterol, radiation imaging for things that did not need imaging or neither was it even the right study. There are soooo many things.

I am only person in family who went to college. It took a long time to practice medicine for a reason. The nursing model is not the way you learn diagnosis. I would not pretend to suddenly be a nurse tomorrow just cause I work with nurses. And fyi we care about the entire patient too and have worked countless unpaid hours to get people help (The nursing model and medicine model both care about the whole patient).

No one wants to listen to MD/DOs when we try to defend patients because they think we are
“Threatened.” No trying to save people. I fear for my own health and families.

I actually used to love working with an NP and PA but now I am afraid to, due to how high the liability is. Also the ones I loved working with had done solid training. One was a nurse for 10 years first. She was incredible. She was a very capable NP and I’d have trusted her as she knew too what she didn’t know. If she had acted like she was just as good or the same people could have died-she knew when to get me. This is not happening now.

I routinely see kids on combinations of psych meds i would loose my license for. I was taught how careful we must be and if so the careful choosing and limiting of types etc….

I could go on but also an NP can change “specialties” as much as they like. Maybe a small course or not. Physicians we have to do an entire residency and fellowship to change. I sure wish we would hire each other though! Makes no sense to me that I can’t open a family clinic as an MD just cause I work in emergency but an NP is allowed to…(then I get to fix it all in the ER when their pts come).

I am not anti NP I am against independent practice after I’ve seen what I’ve seen. I was once open to it and now I am just utterly shocked by what is happening. Speak to MD/DO that were NPs first they can tell you.

The training of NPs now is so all over the place and disorganized it does a tremendous disservice to the NPs who put solid time in and did not do it for money and ego. Many get to pretend to be doctors now. It will come back to everyone but I guess no one values our profession anymore-unless they are dying. There is a reason it takes a long time to get through it all and there are no short cuts f do or a reason.

Sarah writes:

Why on earth would you even consider allowing this to happen? Patient after patient after patient have been harmed and killed by unsupervised, minimally trained nurse practitioners, trying to deliver physician level care for which they are utterly unprepared. Study after study has demonstrated NO improvement in access to care by allowing NP's to "practice" independently. There are no good studies that show equivalency in NP level care even in healthy patients, let alone patients with actual medical problems. Physician supervision MUST protect patients in delivering care in Virginia, and elsewhere. We are the richest, most scientifically advanced country in the world. Our healthcare should be of the highest order. Degrading the level of care is simply crazy. Access is NOT aided by independent practice by NPs. This assertion is untrue. The care NPs provide is NOT equivalent by any standard. DO not put Virginians' health at risk by passing this bill. NPs have a valuable role, working under the supervision of much more highly trained and skilled physicians.

T.Theriault writes:

Horrible idea- i’m dumbfounded this would even be taken under consideration.
Easy way to put this to bed once and for all— set up two hospitals- one all staffed with only arnp’s (zero md/do’s) and the other actual doctors (md/do’s). Let’s see who goes where when really sick or needs surgery and who ever votes in favor of this since you are all fine and good with it-then you and all your family can only be treated by arnp’s!!

Jennifer Cotton writes:

What a terrible bill. The differences in hours of training is so huge, it’s absurd to think this is reasonable. The much of the general public doesn't know the difference in the training or title of healthcare professionals. As an emergency physician, I personally take care of the consequences of these differences. Recently I took care of a patient who had text book heart failure. A second year medical student could have diagnosed it. However they were being treated with repeated rounds of antibiotics for their swelling. They thought their primary care was a physician, but they were not. I admitted the patient for florid heart failure with multiple organs that had been injured as a resulted of long standing untreated heart failure. Please don’t let this happen to others!