In Their Own Words: Free Clinic Nurse Practitioners
Ms. Adamson also has the distinction of being the first NP in Virginia to be issued an autonomous practice license. She reports full support from the two physician medical directors for autonomous practice demonstrated by signatures on NP attestations and support of clinic policy changes in support of full use of NPs. The clinic's governance board has embraced the new law with support for changes to clinical policies by the professional services subcommittee to utilize autonomous licensed NPs to the fullest. Changes in the credentialing of clinicians have been updated. “Essentially, NPs with autonomous practice licenses, once verified and with no sanctions, can begin to see patients.” They are of course added to the clinic's Division of Risk Management clinician list. NPs without autonomous licensure are still assigned to a practice agreement with one of the medical directors. Several "NP slots" have been opened up by autonomous licensed NPs. Additionally, autonomous licensure has increased the ability to spend more time and resources focusing on healthcare delivery instead of the administrative burdens associated with collaborative practice agreements, chart reviews, etc. Ms. Adamson states, “It has been such an easy practice change for us in this setting.”
Rebecca Bates, DNP, APRN, FNP-C practices with the Adams Compassionate Healthcare Network, a free clinic in Northern Virginia. With only four administrative and clinical employees, she is the only paid clinician. The clinic provides medical services to low-income and uninsured individuals for free or at low cost. The clinic has volunteer providers including physicians and a medical director (who owns his own practice). Under a collaborative agreement, Dr. Bates had to ensure the collaborating physician was available for consultation as needed. If he left the country to visit his family overseas or was otherwise unavailable, she would not be able to practice. With autonomous practice licensure, Dr. Bates is not required to practice with a collaborating physician. Additionally, any NPs who have obtained their autonomous practice licensure and wish to volunteer in the clinic do not need to have a collaborative agreement with the medical director. This reduces the required oversight and nullifies the limit on the number of NPs a collaborating physician may have an agreement with at any one time.
Dr. Bates reports that, “autonomous practice has allowed me to seamlessly integrate my scope of practice into the workflow and the care I provide in the clinic.” As a preceptor, her NP students learn to participate in clinical care and consultation as any healthcare provider does. Mandating a single provider for collaboration is an onerous and ineffective model that reduces access to care, particularly in a vulnerable population such as the uninsured. “My students now learn to consider which healthcare provider is the most appropriate for a particular consultation; it is most often not another primary care provider.”
Teresa Tyson, DNP, FNP-BC, FAANP is the executive director of The Health Wagon , a free clinic in Southewest Virginia, and Paula Hill-Collins, DNP, FNP-BC, FAANP is the clinical director. The Health Wagon's mission is to provide compassionate, quality health care to the medically underserved people in the mountains of Appalachia. Ninety-eight percent of the Health Wagon's patients are uninsured. Drs. Tyson and Hill report that the autonomous practice licensure law has removed a tremendous burden of “fear of losing our collaborative physician” who is in his 70s though remains active in practice. The new law has allowed them to add two additional NPs to the clinic. Dr. Collins-Hill states, “The law also permits NPs to freely volunteer without the requirement for a collaborative physician at the M7 Moving mountains medical missions (formerly Wise RAM).” This event, held annually at the Wise Fairgrounds serves thousands of individuals who come to get needed free eye, dental, medical and diagnostic services. The new law has increased access to services provided by the Health Wagon.