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VA Extends Practice Authority to NPs, Expanding Vet Care Access

The rule will allow advanced practice nurse practitioners to practice at the top of their licenses, expanding veteran care access.

The Department of Veterans Affairs has officially granted advanced practice nurse practitioners full practice authority, says a VA news release. The move aims to improve veteran healthcare access by increasing the number of authorized clinicians delivering primary care.

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“Advanced practice registered nurses are valuable members of VA’s health care system,” said VA Under Secretary for Health Dr. David J. Shulkin. “Amending this regulation increases our capacity to provide timely, efficient, effective and safe primary care, aids VA in making the most efficient use of APRN staff capabilities, and provides a degree of much needed experience to alleviate the current access challenges that are affecting VA.”

The VA first proposed this initiative in May of 2016, saying that it planned to allow APRNs to practice at the top of their licenses because of the extensive training these clinicians complete. APRNs are required to have advanced degrees, including masters degrees, post-masters degrees, and post-doctoral degrees, indicating their ability to deliver high-quality healthcare for veterans.

The proposal was met with widespread praise. The American Association of Colleges of Nursing, for example, lauded the proposed rule as a significant step forward for improving veteran healthcare.

"Supporting APRNs in the VHA to practice to their full scope demonstrates a strong commitment to improving care for those who serve our country," said AACN’s president and CEO Dr. Deborah Trautman in a statement. "Academic nursing applauds this visionary step taken by the VHA, and we stand ready to help advance this agenda for the well-being of our nation's Veterans."

The American Association of Nurse Practitioners likewise supported the proposal, and conducted a survey of 1,000 individuals finding that nearly 88 percent agreed.

"Americans recognize NPs' 50-year track record of providing care for our patients, including our nation's veterans, makes nurse practitioners a zero risk, zero cost, zero delay solution for timely, high-quality care in the VA system," said Dr. Cindy Cooke, DNP, FNP-C, FAANP, president of AANP.

AANP likewise approved of the rule’s finalization.

“This final rule is a critical step for America's veterans to be able to obtain timely, high quality care in the Veterans Health System,” Cooke said. “We are pleased the VA will move forward with allowing veterans throughout the country to have direct access to nurse practitioner provided health care.”

However, not all are happy with VA’s final rule. Although the agency is enacting its proposal, it has made some changes that for some are not popular.

Originally, the proposal called for expanded practice authority for certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse-midwives. However, according to this most recent announcement, VA will not expand practice authority to certified registered nurse anesthetists.

“Though VA does have some localized issues, we do not have immediate and broad access challenges in the area of anesthesia care across the full VA health care system that require full practice authority for all Certified Registered Nurse Anesthetists (CRNAs),” the agency explained.

“Therefore, VA will not finalize the provision including CRNAs in the final rule as one of the APRN roles that may be granted full practice authority at this time.”

The American Association of Nurse Anesthetists did not respond well to that provision, issuing the following statement from the group’s president, Cheryl Nimmo, DNP, MSHSA, CRNA:

“This is an example of the kind of potentially dangerous decision making within the VA that has led to all-too-frequent media reports of terrible neglect and bad outcomes in VHA facilities,” Nimmo said.

“Without question, this speaks to the underutilization of CRNAs who are not allowed to practice to the full scope of their education, experience, and licensure in VHA facilities,” she continued. “It also raises the same concerns about anesthesiologists who spend their time supervising CRNAs rather than actually providing hands-on patient care, even though CRNA supervision is not required by the VA.”

According to Shulkin, the VA is still accepting comments on the rule regarding this provision.

“CRNAs provide an invaluable service to our Veterans,” Under Secretary for Health Shulkin continued. “Though CRNAs will not be included in VA’s full practice authority under this final rule, we are requesting comments on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking.”

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