In an effort to ensure access to timely, quality healthcare for America’s veterans, the Veterans Health Administration (VHA) has published a proposed rule in the May 25 Federal Register that allows Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice registered nurses (APRNs) to provide patient care to the full extent of their education and abilities.
The policy change, which is consistent with recommendations from the National Academies of Medicine (formerly the Institute of Medicine), would define Full Practice Authority in VHA facilities for CRNAs, Nurse Practitioners, Clinical Nurse Specialists and Certified Nurse Midwives. Its definition of Full Practice Authority means that APRNs working within the scope of VA employment would be authorized to practice as described in the law in section 17.415(b) “without the clinical oversight of a physician, regardless of state or local law restrictions on that authority.”
The proposal is supported by more than 60 organizations, including veterans’ groups such as the Military Officers Association of America and the Air Force Sergeants Association. The policy is also supported by AARP (whose membership includes 3.7 million veteran households), numerous healthcare professional organizations including the American Association of Nurse Anesthetists (AANA) and other APRN associations, and 80 Democratic and Republican members of Congress.
“The AANA and its 49,000 members are one of many groups cheering the VHA’s actions today,” said AANA President Juan Quintana, DNP, MHS, CRNA, a nine-year veteran of the Air Force Reserve. “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.”
With more than 1,700 facilities across 50 states, the District of Columbia and several territories, the VHA is the nation’s largest healthcare system, serving over 21 million veterans. In an organization this size, improving access to timely care can be a complex problem. However, with more than 6,000 currently employed and under-utilized APRNs, a big part of the solution was already available to the VHA.
“Improving the VHA’s ability to provide better, faster care to our veterans doesn’t necessarily require increasing budgets or staff,” said Quintana. “One solution has been there all along, and 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 VHA proposed rule was backed by the results of an independent assessment of the VHA health system that was ordered by Congress and published in 2015. The researchers recommended that allowing CRNAs and other APRNs to practice to the full extent of their education and abilities would increase veterans’ access to care, reduce wait times, and even save money.
The rule makes the VHA consistent with the U.S. Military service branches, which allow CRNAs and other APRNs to practice to the full scope of their education and abilities. Nurse anesthetists, who first provided healthcare to wounded soldiers on the battlefields of the American Civil War, have been the main providers of anesthesia care on the front lines of every U.S. military conflict since World War I.
Immediately upon publication in the Federal Register, a 60-day comment period commenced during which interested parties can communicate with the VHA about the rule.