VA Recommends Allowing Advanced Practice Nurses to Practice Independently

The Department of Veterans Affairs (VA) has proposed a rule that would grant full practice authority to all VA advanced practice registered nurses (APRNs) when acting within the scope of their VA employment. The rule is intended to increase veterans’ access to VA health care by allowing qualified health-care professionals to provide care without the clinical supervision of physicians.

According to the proposed rule, APRNs would be categorized as: certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse midwives.

The rule also provides the criteria under which the VA may grant full practice authority to an APRN, and defines the scope of full practice authority for each category of APRN, noting that the services provided by an APRN in one of the four roles would be consistent with the nursing profession’s standards of practice for each role.

Physician groups, including the American Medical Association (AMA), have offered public comments opposing the proposed rule. “The AMA is disappointed by the VA’s unprecedented proposal to allow APRNs within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law,” said Stephen R. Permut, MD, JD, board chair of the AMA, in a statement. “The AMA urges the VA to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes.”

The American Society of Anesthesiologists (ASA) also released a statement opposing the rule, noting that although the rule is designed to combat a shortage of physicians in the VA system, there is no shortage of physician anesthesiologists. “Surgery and anesthesia are inherently dangerous requiring physician involvement, particularly for veterans who are sicker and often have multiple medical conditions that put them at greater risk for complications,” said Daniel J. Cole, MD, president of the ASA, in a statement.

Nursing groups, though, have a more favorable opinion of this rule. The American Association of Nurse Anesthetists (AANA) said that the VA rule parallels common practice in the field for combat nurses. “Improving the Veterans Health Administration’s ability to provide better, faster care to our veterans doesn’t necessarily require increasing budgets of staff,” said Juan Quintana, DNP, MHS, CRNA, president of the AANA. “One solution … is as simple as removing bureaucratic barriers to APRNs’ ability to be credentialed and practice to the full extent of their education, training, and certification.”

The American Nurse Association has offered cautious support for the rule, noting in a statement, “Limiting APRNs’ practice in the VHA puts our veterans at risk due to backlogs and waitlists for receiving treatment.”

Health-care professionals can comment on the document through July 25, 2016.

Sources: Federal Registrar, May 25, 2016; American Medical Association, May 25, 2016; Fierce Healthcare, May 26, 2016.