As a certified registered nurse anesthetist (CRNA) who also happens to be a military veteran, it has frustrated me greatly over the years that so many veterans have had to endure long wait times to receive needed health care, despite the best efforts of the Veterans Health Administration (VHA) to improve veterans’ access to essential health care services. But finally there is a light at the end of the tunnel, as the VHA revealed its plan to solve this long-standing problem in a proposed rule published in the May 25 Federal Register.
The solution has been right there all along, and it won’t require a budget increase or massive hiring to enable the VHA to provide better, faster care almost immediately to veterans. Instead, it will simply require the VHA to utilize its 6,000-plus CRNAs and other advanced practice registered nurses (APRNs), including nurse practitioners, clinical nurse specialists and certified nurse midwives, to practice to the full extent of their education, training and certification. This means that APRNs working within the scope of Department of Veterans Affairs employment would be authorized to practice as described in the law in section 17.415(b) “without the clinical oversight of a physician, regardless of state or local law restrictions on that authority.” It’s that simple.
At this pivotal moment, the VHA should be commended for recognizing the availability of existing, under-utilized resources (APRNs) to help solve this access-to-care problem. The VHA should also be commended for standing up to special interest groups such as organized medicine that oppose the VHA’s plan. The proposed rule was backed by the results of a congressionally ordered independent assessment of the VHA health system and is consistent with a report from the National Academies of Medicine (formerly the Institute of Medicine), both strongly recommending that CRNAs and other APRNs be allowed to practice to the full extent of their education, abilities and experience.
The idea of using APRNs to the full scope of their practice reflects the way the Department of Defense (DOD) already ensures top-notch care for active-duty personnel in all military service branches. APRNs are granted full practice authority under the DOD system. Nurse anesthetists, for instance, first provided health care to wounded soldiers on the battlefields of the American Civil War, and have been the main providers of anesthesia care on the front lines of every U.S. military conflict since World War I. If these specialists can treat soldiers who just sustained horrific injuries during battle, then why not enable them to fully treat these same soldiers when they return home and need health care?
More than 60 organizations support this policy change, including veterans’ groups such as the Military Officers Association of America and the Air Force Sergeants Association. The policy is also supported by AARP (whose membership includes 3.7 million veteran households), numerous health care professional organizations including the American Association of Nurse Anesthetists (AANA) and other APRN associations, and 80 Democratic and Republican members of Congress.
The VHA’s proposed rule aimed at improving access to quality health care for veterans stands to become a crowning achievement in the VHA’s long history. Public comments on the rule will be taken for another month or so. It is critically important that our elected officials hear from all concerned citizens, especially veterans. Share your story with them.
Juan Quintana is president of the American Association of Nurse Anesthetists. He also served in the U.S. Air Force Reserve.