Certified nurse midwives/licensed certified midwives; independent practice, organized medical staff.
Summary
SB1352 revises Virginia law governing certified nurse midwives, licensed certified midwives, and certain advanced practice registered nurses. The bill expands and clarifies when nurse practitioners, certified nurse midwives, clinical nurse specialists, and licensed certified midwives may practice without a written or electronic practice agreement, generally after meeting experience thresholds and obtaining required attestations. It also preserves collaboration and consultation requirements, including referral obligations, access to physician input for complex cases and emergencies, and limits on independent practice for newer practitioners.
For certified nurse midwives and licensed certified midwives, the bill sets a 1,000-hour practice threshold before independent practice is allowed, with attestation requirements documenting prior consultation and collaboration. It also authorizes licensed certified midwives to prescribe Schedules II through VI controlled substances under board regulations and requires disclosure to patients receiving out-of-hospital care about risks associated with certain births. In addition, the bill directs the Department of Health to amend the definition of “organized medical staff” so that it may include other practitioners, including independent practice midwives, not just physicians and dentists.
Impact
The bill amends Code of Virginia §§ 54.1-2957 and 54.1-2957.04 and directs a regulatory change to 12VAC5-410-10. Its practical effect is to broaden independent-practice pathways for certain advanced practice clinicians while keeping board oversight, documentation, and consultation standards in place. It also expands the role of licensed certified midwives by confirming controlled-substance prescribing authority and by clarifying their participation in organized medical staff structures.
Sentiment
The bill appears to have been broadly supported and noncontroversial in the recorded votes, passing the Senate and House unanimously after favorable committee reports. The vote history suggests strong bipartisan or cross-chamber agreement on the measure’s approach to midwifery and advanced practice nursing. No committee transcripts were provided, so the available record shows consensus rather than debate.
Contention
The main policy tension in the bill is between expanding independent practice for midwives and advanced practice registered nurses and preserving physician oversight, consultation, and referral safeguards. Potential points of concern include the experience thresholds for independent practice, the use of attestations instead of direct supervision, and the authorization for licensed certified midwives to prescribe controlled substances. The bill also touches on hospital staffing and credentialing by allowing organized medical staff to include independent practice midwives, which could affect how facilities structure privileges and governance.