The Department of Veterans Affairs (VA) has just released a controversial proposal that would give full practice authority to advanced practice nurses (APRNs) who work at the VA. Under the new rule, the nurses would be allowed to practice without physician supervision within the scope of their VA employment, regardless of state law. This would include diagnosing and managing patients with acute and chronic illnesses, prescribing medications and ordering and interpreting diagnostic tests, among other things.
The VA has recently been under fire over long wait times for appointments. Implementation of the new rule is intended to increase access to primary care providers, which would help the agency to meet a growing demand for medical services. “The purpose of this proposed regulation is to ensure VA has authority to address staffing shortages in the future,” VA Under Secretary for Health Dr. David J. Shulkin, said in a statement.
The rule would subdivide APRNs into four categories:
- Certified nurse practitioner;
- Certified registered nurse anesthetist (CRNA);
- Clinical nurse specialist; and
- Certified nurse-midwife.
It would then provide the criteria under which the VA may grant full practice authority to an APRN, and define the scope of practice for each nurse category.
According to Shulkin, Veterans Health Administration (VHA) policy would clarify whether and which of the four APRN roles would be granted full practice authority. “At this time, VA is not seeking any change to VHA policy on the role of CRNAs, but would consider a policy change in the future to utilize full practice authority when and if such conditions require such a change,” Shulkin emphasized.
Proposed rule draws physician ire
Whether or not APRNs should be able to practice without physician supervision has long been a hot button topic for physicians. In a press release, Stephen R. Permut, MD, the American Medical Association’s (AMA) Board Chair, said the AMA believes the proposed rule would “significantly undermine the delivery of care within the VA.”
“While the AMA supports the VA in addressing the challenges that exist within the VA health system, we believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans,” Permut said.
The American Association of Anesthesiologists said the proposed rule would lower the standard of care and jeopardize Veterans' lives.
Nurses praise the proposed rule
The American Nurses Association (ANA) is pleased with the VA’s proposal. “ANA applauds the proposal as a major step in removing barriers that prevent APRNs from providing a full range of health care services,” the organization said in a statement.
"Veterans stand to significantly benefit from this essential VA policy update, which gives them unencumbered access to nurse practitioners and the excellent, compassionate and patient-centered care they provide," said Cindy Cooke, president of the American Association of Nurse Practitioners.
Will increased scope of practice for nurses become the norm?
Nurses in military hospitals have had full practice authority for years. And 21 states and the District of Columbia have already expanded scope of practice for APRNs. In light of current and projected physician shortages, it’s not unreasonable to believe that others will follow suit. In the meantime, due to the VA’s high visibility, all interested parties will likely be keeping an eye out to see how this plays out.
Comments on the proposed rule are being accepted until July 25.