In a move intended to give veterans more timely access to healthcare, the Department of Veterans Affairs will expand the scope of practice of most advanced practice registered nurses (APRNs) who work for the agency.
Under a final rule (PDF) that will be published in the Federal Register on Dec. 14, the VA will amend its regulations to permit full practice authority for three types of APRNs. The final rule thus expands the pool of qualified healthcare professionals who are authorized to provide primary healthcare and other services to the full extent of their education and abilities without the clinical supervision of physicians.
The move is seen as a victory for nurse practitioners who had supported the change. The VA will allow three categories of APRNs—certified nurse practitioners, clinical nurse specialists and certified nurse-midwives—to practice independently. A fourth category—that of certified registered nurse anesthetists (CRNAs)—is not included under the final rule, but the federal agency is asking for comments “on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking.” The VA issued the final rule, effective 30 days after publication, with a 30-day comment period.
The VA proposed expanding the scope of practice for APRNs after two years of turmoil that began when an investigation into allegations that a Phoenix Veterans hospital used a secret waitlist to cover up treatment delays revealed a nationwide problem of veterans dying while waiting months for care. Allowing APRNs to provide services would give veterans greater and more timely access to care.
The proposed rule issued last May divided physicians and APRNs on both sides of the issue. The proposal to allow CRNAs to practice independently was particularly controversial, with the American Society of Anesthesiologists launching a campaign against that change saying that replacing physician anesthesiologists with nurse anesthetists would reduce the standard of care for veterans.