If Marsha Stonehill’s patients aren’t comfortable talking in her office, she may suggest they go outside for a walk.
“Or we can sit by the water or even go out in the kayak,” she said.
Stonehill is a psychiatric nurse practitioner who’s able to offer that kind of flexibility because she has her own practice, Melt The Ice, in King George County. She and approximately 8,000 other nurse practitioners in Virginia never had the opportunity to operate on their own until Jan. 7, when legislation passed by the General Assembly went into effect.
It allows NPs, who typically work in specialty areas, to maintain a practice without a supervising physician. NPs don’t have the same level of education as medical doctors, but they can make diagnoses and prescribe medicine.
Stonehill opened her practice in March, 16 years after she became a NP and 26 years after she became a registered nurse. She can consult with patients about their stress and anxiety, feelings of rejection or problems making transitions, wherever they’re most comfortable.
Because she’s not associated with a big medical practice, she doesn’t have to conform to corporate policies. She’s chosen not to accept insurance, and she’s the only one who answers the phone or schedules appointments. Instead of having to book one patient after another, as bigger practices dictate, she can schedule longer visits or leave time between them, in case someone has a crisis.
Stonehill says she’s been in situations when she’s had to wrap up a session before a client was finished.
“I’ve apologized a lot,” she said, adding her patients seemed understanding. “They all rolled with it because that’s how our system is set up.”
Del. Roxann Robinson, R–Midlothian, set out to change the nurse practitioner system with HB 793, which passed last year. A Chesterfield County optometrist, Robinson wanted to remove the restrictions on board-certified NPs, whom she called “an instrumental part of health care in Virginia.”
The bill modernized the way they are allowed to practice, “a way that almost half of the country has already seen as valuable,” Robinson stated in a press release. Currently, 23 states allow NPs to work independently.
Virginia’s law requires NPs to have at least five years of full-time clinical experience and documentation from a supervising physician attesting to the collaboration between the two. Those who don’t have a practice agreement must establish a plan for referring complex medical cases or emergencies to physicians or other appropriate health care providers, according to the bill.
Those against the autonomous practice say oversight is required because doctor have more training. The difference is particularly acute in the field of primary care, says a family physician, author and blogger in California.
“It boils down to training,” said Dr. Davis Lui. “Primary care is a cognitively challenging specialty. The amount of training doctors receive is far greater than that of nurse practitioners.”
But the Virginia Council of Nurse Practitioners argues that requiring a practice agreement is a barrier to care, especially in free clinics or rural areas where there’s already a shortage of medical providers. Under the old practice, when collaborating physicians retired, the NPs lost their ability to see patients. Or, NPs never found a collaborating practice to begin with, for reasons ranging from noncompete clauses and malpractice insurance to the fee charged the NP by the doctor.
‘UNSUNG HERO’ AWARD
Stonehill, 52, is a classic example of a quote she shares about life’s journey.
“There’s what you think will happen, and there’s what actually happens,” she said.
She grew up in the Shenandoah Valley, got her nursing degree from Eastern Mennonite College in 1993 and worked in various departments such as the emergency room, critical care and home health. She eventually focused on eating disorders and intervention care, went back to school in 2003 and earned her master’s degree from the University of Virginia. She became a psychiatric nurse practitioner and crossed the country to San Diego to work in treatment centers.
She loved the coastal city and figured she’d stay there, but a job opportunity in 2007 brought her back east. She went to work for Remuda Ranch in Caroline County, which dealt with eating disorders, and as she looked for a place to live, she landed in King George.
“It felt like home,” she said.
There, she met Jeff Stonehill, who was working with the King George Sheriff’s Office. He’s originally from Connecticut, “but somehow we both landed here and found each other,” she said.
The two married in 2013.
After Remuda closed, Marsha Stonehill worked as the first staff psychiatric nurse practitioner at the Lloyd F. Moss Free Clinic in Fredericksburg. She created a treatment plan to support chronically ill patients suffering from several mental health issues, such as anxiety, depression and trauma.
In 2013, the Virginia Health Care Foundation gave her its “Unsung Hero” award for providing care to hundreds of local residents without insurance, said Karen Dulaney, the clinic’s executive director.
“We are delighted to know that Marsha’s energy, expertise and intuition will be used in her new practice,” Dulaney said.
Marsha Stonehill left Moss in 2017 after she and her husband bought the Machodoc Creek Marina in Dahlgren. She manned the marina until he retired from law enforcement in February and took over its operation.
Initially, she assumed she’d have to find another doctor’s office to work, then she heard about the legislation regarding nurse practitioners. She helped lobby for its passage and was amazed at how the schedule fell into place.
“It was uncanny, all in perfect timing,” she said.
Her practice, Melt The Ice, is set up in front of the marina, in the former Elizabeth Quesenberry home. That’s where those helping John Wilkes Booth sought assistance after the assassination of Abraham Lincoln.
Her office is on the first floor, in a wide-open room with wooden floors and exposed rafters. She’d eventually like to set up space upstairs, at the top of creaky steps. From there, patients could gaze at Machodoc Creek—and talk about what’s on their minds.