Physicians take issue with VA's proposed rule for APRNs to work to top of license

The U.S. Department of Veterans Affairs proposed a rule to give advanced practice registered nurses full practice authority without physician supervision to help expand the pool of providers for the VA Health Care System, according to a notice published in the Federal Register. However, some physicians are up in arms about the proposed policy — particularly anesthesiologists.

The American Society of Anesthesiologists established its opposition to the proposal Tuesday, saying giving APRNs full practice authority would lower the standard of care for veterans and jeopardize lives. The American Medical Association agreed. AMA board chair Stephen Permut, MD, said in a statement, "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. We feel this proposal will significantly undermine the delivery of care within the VA."

The VA said in its announcement that the proposal would allow the agency to use resources more effectively by employing APRNs as they are in the non-VA healthcare sector. To make this transition, the rule provides criteria for the VA to grant full practice authority to nurses and defines the scope of full practice authority for four different types of APRNs: certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist and certified nurse-midwife. Each of these categories has a unique defined scope of practice under the proposed rule.

For example, certified registered nurse anesthetists would have the authority to provide anesthesia care and anesthesia-related care for patients, including planning and initiating general, regional and local anesthetic. They would also have the authority to provide post-anesthesia evaluation and discharge, order and evaluate tests, request consultations and perform point-of-care testing.

The American Society of Anesthesiologists says the VA's chiefs of anesthesiology feel the policy "would directly compromise patient safety and limit our ability to provide quality care to veterans." Furthermore, they say their requests to meet with VA leadership have been ignored. The society says the policy would block veteran access to 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," ASA President Daniel Cole, MD, said in a statement.

However, the policy is supported by a number of other healthcare organizations, such as the American Association of Nurse Anesthetists. AANA President Juan Quintana, who is a certified registered nurse anesthetist and Air Force veteran, said in a statement, "Veterans are waiting entirely too long to receive the quality healthcare they deserve and have earned in service to our country. The AANA strongly supports the VHA's plan to solve this problem by utilizing readily available healthcare resources — such as CRNAs, nurse practitioners, and other APRNs — to the full extent of their practice authority."

The proposed rule is open for comment until July 25.

Note: This article was updated May 26 at 2:50 p.m. CT to include a statement from the American Association of Nurse Anesthetists.


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