Docs, nurses debate VHA's proposed scope-of-practice measure

Doctors around the country are upset about the Veterans Health Administration's (VHA) proposal to let nurses with advanced training practice medicine without physician supervision, while nurses applaud the move, according to a Wall Street Journal report.

The proposed nursing handbook would recognize 6,135 advance-practice registered nurses, including nurse practitioners (NPs), nurse anesthetists, nurse midwives and clinical-nurse specialists, as independent practitioners who could care for patients at VHA hospitals, clinics and veterans centers without a doctor's supervision, according to the article.

Nurses say the measure would deliver high-quality care for veterans in a more timely fashion, while doctors argue it would eliminate physician-led team-based care within a system already struggling to treat an influx of veterans dealing with physical and mental issues, the WSJ reported. Last month, the VHA began allowing individual physician assistants (PA) and their collaborating physicians to determine how much autonomy the PA should have.

The American Society of Anesthesiologists said allowing nurse anesthetists to work unsupervised would decrease quality of care, and that physicians are better equipped to handle emergencies. The American Association of Nurse Anesthetists countered by arguing that physicians were only interested in protecting their jobs, citing studies that showed no difference in patient outcomes when comparing anesthesia administered by physicians and nurse anesthetists. The organization also claimed that allowing nurse anesthetists to work independently is a more cost-effective care model, according to the WSJ.

The disagreement reflects a scope-of-practice debate happening across the country as PAs and NPs take on more responsibilities to help make up for the nationwide physician shortage.

Physicians and nurses perceive their primary care roles and skills differently, as well as the effects of expanded NP roles on cost and care quality, according to a survey of 972 clinicians published last May in the New England Journal of MedicineFierceHealthcare previously reported. More than 66 percent of surveyed physicians agreed that doctors provide a "higher quality of examination and consultation" than NPs, while more than three-quarters of the surveyed NPs disagreed. Moreover, 77 percent of NPs reported their expanded role would reduce costs, while only 31.1 percent of doctors expect costs savings from expanded NP roles.

To learn more:
- here's the WSJ article (log in or subscription required)