Physicians, anesthesiologists oppose VA's plans for advanced practice registered nurses

Some healthcare groups have voiced opposition to the Department of Veteran Affairs proposed rule that would give advanced practice registered nurses (APRNs) expanded practice authority, citing concerns about a lack of clinical oversight from physicians.

Stephen R. Permut, M.D., board chair of the American Medical Association (AMA), released a statement Wednesday saying the organization is "disappointed" in the VA's proposal. "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. "We feel this proposal will significantly undermine the delivery of care within the VA."

Patients "deserve access to physician expertise," Permut continued, with the AMA urging the VA to maintain its physician-led model.

The American Society of Anesthesiologists (ASA) also released a statement opposing the VA rule, saying that replacing physician anesthesiologists with nurses lowers the standard of care and could jeopardize the lives of veterans. In the statement, the ASA notes that the rule is designed to combat a shortage of physicians in the VA system, but the organization says 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," ASA President Daniel J. Cole, M.D., said in the statement.

Although physician groups oppose the plan, nursing organizations applaud the move. The American Association of Nurse Anesthetists (AANA) said in a statement that the VA rule parallels common practice in the field for combat nurses. Nurse anesthetists have provided anesthesia care on the front lines since World War I, the organization said. "Improving the VHA's ability to provide better, faster care to our veterans doesn't necessarily require increasing budgets or staff," said AANA President Juan Quintana in the statement. "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 American Nurses Association has also offered cautious support for the potential rule before it was officially published. "Limiting APRNs practice in the Veterans Health Administration puts our veterans at risk due to backlogs and waitlists for receiving treatment," the organization writes on its advocacy website.

To learn more:
- read the AMA statement at the Federal Register
- here's the ASA statement
- view the AANA statement
- check out the ANA website