Advance practice nurses don’t need physicians to supervise them, advocates say.
Joyce Frieden News Editor, MedPage Today
WASHINGTON — Advance-practice nurses have the skills and abilities to take good care of patients, and they should be able to practice independently within the Department of Veterans Affairs (VA) medical system, several nursing and military organization spokespeople said at a press briefing here.
“Our veterans are waiting too long to get the healthcare they have earned and they deserve,” Juan Quintana, CRNA, president of American Association of Nurse Anesthetists, in Park Ridge, Ill., said at the briefing on Tuesday. “We, as advance practice registered nurses (APRNs) all realize we’re ready and capable [of providing] the services that are necessary for our veterans today. We fully support the proposal by the VA to expand veterans’ access to care by recognizing APRNs to the full extent of their education and skills.”
Despite all the VA’s efforts so far, veterans still need better access to care, Quintana said. “In anesthesia, for example, an independent VA assessment indicated that anesthesia services and access to those services was one of the limiting factors to veterans getting surgical care — sometimes [causing veterans to wait] months to get those services,” including cardiac procedures and colonoscopies.
The proposed rule, published May 25 in the Federal Register, would allow advance practice nurses working within the VA system to practice at the top of their licenses independent of physician supervision, regardless of what their state’s laws are. The proposal includes nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists (CRNAs).
Quintana noted that CRNAs “have been administering anesthesia for 150 years. We provide services in underserved areas, [rural areas], and at some VAs without anesthesiologist involvement, and in forward surgical teams that provide services to our soldiers in harm’s way. In terms of safety … our studies show we are very safe at what we do.”
“Our opposition brings little to no evidence; their arguments go nowhere,” he continued. “We have nine different studies done since 2000 that prove that anesthesia done by CRNAs is equal to our anesthesiologist colleagues.” In particular, he cited a study published in May in the journal Medical Care which found no evidence that odds of anesthesia complications varied by either scope of practice or delivery model.
After the proposal was published, the VA clarified its initial press release to explain that “At this time, VA is not seeking any change to [current] policy on the role of CRNAs, but would consider a policy change in the future to utilize full practice authority when and if such conditions require such a change.”