VA's proposed rule would give APRNs full practice authority

The Department of Veterans Affairs aims to expand the scope of practice of advanced practice registered nurses (APRNs) who work for the agency in order to provide veterans with greater and timely access to care.

Under a proposed rule published today in the Federal Register, the VA said it intends to expand 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 VA proposes to subdivide APRNs into four categories that include certified nurse practitioners, certified registered nurse anesthetists (CRNAs), clinical nurse specialists and certified nurse-midwives. The agency said it intends to set criteria under which APRNs will receive full practice authority and that any services they provide would be consistent with the nursing profession's standards of practice.

The VA released the new plan 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.

Despite attempts to reduce wait times by allowing veterans to seek care private clinics and physicians, the problems have not been resolved and were heightened this week when Secretary Robert McDonald compared the long waits to visitors who wait in line at Disney theme parks. Rather than measure the number of hours visitors wait in line, Disney measures the overall satisfaction with the experience.The VA, he said, should do the same, the Washington Examiner reported. Although McDonald now says he deeply regrets the remarks, many lawmakers are calling for his resignation, Fox News reports.

The VA's latest proposal, if implemented, will help veterans who have been waiting too long to receive quality healthcare, according to the American Association of Nurse Anesthetists (AANA), one of 60 organizations that support the proposal. AANA President Juan Quintana said in a statement that the Veterans Health Administration's (VHA) plan will help solve the wait problem by using the 6,000 readily available but underutilized APRNs to the full extent of their practice authority.

"Improving the VHA's ability to provide better, faster care to our veterans doesn't necessarily require increasing budgets or staff," said 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."

If finalized, the rule would make 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.

Meanwhile, in another effort to reduce wait times, this week CVS announced a partnership with the VA's Palo Alto Health Care System in California to offer veterans care at the pharmacy chain's MinuteClinics.

To learn more:
- here's the proposed rule (.pdf)
- read the AANA's statement
- check out the Washington Examiner article
- see the Fox News article