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Evidence Trumps Politics When It Comes to APRNs

Analysis  |  By Jennifer Thew RN  
   July 05, 2016

Nursing and veterans' organizations have united to advocate for adoption of the VA's proposal to allow its advanced practice registered nurses full practice authority.

It's time to put egos and hyperbole aside and start focusing on improving U.S veterans' access to timely, high-quality healthcare, nursing and veterans' organizations say.

A recent news conference addressed the Department of Veterans Affairs' proposal to amend its medical regulations and permit "full practice authority of all VA advanced practice registered nurses when they are acting within the scope of their VA employment."

"It's time for evidence to trump politics when it comes to the health of our veterans. And there's no evidence for the arguments of the groups opposing the rule [it's] all baseless rhetoric," said Juan Quintana, DNP, MHS, CRNA, president, American Association of Nurse Anesthetists, during the June 28 news conference at the National Press Club in Washington, DC.

In addition to the AANA, the American Association of Nurse Practitioners, the American Nurses Association, the American Association of Colleges of Nursing, the Air Force Sergeants Association, and the Military Officers Association of America, voiced their support for the rule during the event.

Unacceptable Wait Times

Par for the course, the American Medical Association and other physician's organizations are against the proposal.

They claim that allowing APRNs full-practice authority "will significantly undermine the delivery of care within the VA," and that veterans' deserve access to physician expertise.

What these physicians' groups don't seem to understand is that access to care has already been compromised.

Despite the 2014 high-profile scandal regarding VA wait-times, a U.S. Government Accountability Office review released in April 2016 found that many of the veterans it surveyed  "waited from 22 days to 71 days from their requests that VA contact them to schedule appointments to when they were seen."

"The waiting is unacceptable," says CMSGT Robert L. Frank, USAF (Ret), chief executive officer of the AFSA. "We're excited about this rule to allow the 6,000 APRNs currently employed by the VHA to be used to their full potential. Let them serve our veterans."

APRNs Can Improve Access

A move to full-practice authority would help address the access issue says, CAPT (Ret) Kathryn Beasley, USN, PhD, FACHE, a retired Navy nurse and deputy director of government relations for MOAA.

"In the Navy, we would never train a sailor ten skills, then limit them to using only three. It makes no sense. No one would do that," she says.

"But that's what illogical and wasteful practice limitations on highly skilled advanced practice nurses do. Our veterans need all the skills advanced practice registered nurses can provide them."

Since APRNs are already in place at the VA and have the training and education necessary to provide veterans with healthcare, moving to a full-practice environment is a cost-effective and timely solution to barriers in access to care, says Cindy Cooke, DNP, FNP-C, FAANP, president of the AANP.

"The proposed rule is [a] zero-risk, zero-delay, and a zero-cost solution to ensuring veterans have access to needed health care," she says. "We applaud the VA for taking this important action, which will immediately improve veterans' access to care. And we are doing everything we can to support its proposal." 

This includes providing and encouraging public comments on the rule, which can be submitted until July 25.  In fact, the number of public comments on this rule—over 46,000 at half-way into the comment period—is the largest number of comments for a VA rule since online submission began in 2006.

Some echo the fears of physicians' groups, including the concern that the change would "force the best trained physicians out of the operating room."  Others support the move and take issue with those in opposition to full-practice.

The AANA's Quintana, who also served in the Air Force Reserves, says a review of comments thus far shows that about two-thirds of respondents support the rule.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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