University of Virginia School of Nursing
DNP students Cindy Fagan (2nd from left) and HoChong Gilles (far right) pose with Del. Roxann Robinson, author of HB #793 that promotes practice autonomy for Virginia's nurse practitioners.

At the Virginia State House, it’s been something of a white coat brigade.

Along with hundreds of others, UVA nursing students HoChong Gilles and Cynthia Fagan (DNP `18)—clad in their white nursing jackets—have taken the Richmond State House by storm, throwing their collective weight behind a bill meant to ease the “arbitrary, outdated, and costly” practice restrictions for the Commonwealth’s roughly 6,000 nurse practitioners.

Fagan and Gilles—both family nurse practitioners with more than 50 years’ experience between them—are two of House Bill 793’s most vocal champions. They say it’s high time that Virginia lift the onerous laws that require NPs to be monitored by a supervising physician, and enable nurse practitioners—98 percent of whom have at least a master’s degree and a certification in their specialty areas—to practice to the fullest extent of their education.

If passed, it would remove the career long requirement for a practice agreement with a physician. Under the current law, NPs are required to enter into often costly business contracts with physicians who act as “collaborating providers” overseeing their care. But with declining numbers of physicians entering primary care roles, many NPs—especially those working in medically underserved areas—are often forced to quit or close their practices if they can’t secure a collaborating physician within 120 days, their collaborating partner dies, relocates, or retires.

As a result, says Gilles, many NPs educated in Virginia move to neighboring states offering greater practice autonomy, like West Virginia, Maryland, and Washington, D.C. Virginia is one of 12 states with the greatest practice restrictions for NPs, even as many more Virginians—especially those in rural areas—are in need of care.

“The intent of this bill is really to increase access to care for citizens of the Commonwealth,” says Fagan, who cares for veterans at the McGuire Veterans’ Hospital in Richmond, “and of course we know that access to primary care is the cornerstone of good health.”

Advocacy and service roles are nothing new to Fagan and Gilles, friends since their graduate nursing days in the 1990s, and doctoral students at UVA School of Nursing. Throughout their careers, the two have remained active in a number of professional nursing organizations, and kept abreast of legislative issues related to nursing and medicine. Today, their volunteer roles with VCNP bring them to the State House, in contact with legislators, as they champion greater autonomy for Virginia NPs.

It’s a lesson in real time, too, they say, as their advocacy runs concurrent with their graduate studies.

Being a DNP student “provided us with a broader perspective, and made us look at what we’ve been fighting for through a different lens,” says Gilles. “Being part of this process has broadened our education, too, the framework we’ve used to approach the political arena.”

Though it’s cleared its first subcommittee hurdle, the bill—introduced by Republican Roxann Robinson of Chesterfield—headed to the full HWI Committee Feb. 6 for discussion before moving forward for a vote. And while it was amended to require nurse practitioners have 10,000 hours of clinical experience before being granted practice autonomy, rather than its original 1,040, both Gilles and Fagan are hopeful an agreement somewhere in the middle might be made.

And “that’s when the work really starts happening,” says Gilles. “It’ll require a lot more effort to get the bill in a position where it still achieves its original intent. So much of this is politics, and we haven’t yet made a lot of racket yet, but we’ve presented ourselves well, and if we’re not success this session, we’ll be at a higher place next year.”
And with support from UVA Nursing faculty and their peers, they say they’re in it for the long haul.

“We won’t give up,” adds Fagan, “and we will be back."