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Nurse Anesthetists Want Full-Practice Authority

Analysis  |  By Kenneth Michek  
   June 22, 2018

After a report identifies an anesthesia provider shortage at the VHA, the American Association of Nurse Anesthetists calls for the system to grant CRNAs full-practice authority.

After a hotly debated comment period, the Department of Veterans Affairs announced in December 2016 it was amending its provider regulations to allow full-practice authority to APRNs employed at the VA. That is with one exception—certified registered nurse anesthetists.

At the time, the agency said there were no immediate and broad patient access challenges to anesthesia care across its health system and, therefore, it chose not to finalize the provision which included CRNAs as one of the APRN roles receiving full-practice authority.

But a new report published last week by the VA's Office of the Inspector General tells a different story—one that has the American Association of Nurse Anesthetists calling for the agency to revise the rule and grant CRNAs full-practice authority.

The Extent of the Shortage

The report found there is a provider shortage in anesthesiology at 22% of the Veterans Health Administration facilities. This is in direct contrast to the rationale behind the VA’s final rule denying CRNAs nurse anesthetists full-practice authority.

As stated in the final rule, that denial was not due to any lack of capability on the part of CRNAs.

"The safety of CRNA services has long been recognized by the VHA and underscored by peer-reviewed scientific studies, including a major study published in Health Affairs which found that anesthesia care by CRNAs was equally safe with or without physician supervision," the rule says.

Rather full-practice authority was withheld because, according to the final rule, there was "no shortage of physician anesthesiologists in VA and the current system allows for sufficient flexibility to address the needs of all VA hospitals."

In a bit of foreshadowing, the final rule states that if the agency learns "of access problems in the area of anesthesia care in specific facilities… or if other relevant circumstances change, we will consider a follow-up rulemaking to address granting full-practice authority to CRNAs."

AANA Calls for Action

In light of the OIG’s report, the American Association of Nurse Anesthetists there is no better time than now to revise the rule.

"Improving the VA’s ability to provide better, faster care to our veterans doesn’t require increasing budgets or staff," AANA President Bruce Weiner, DNP, MSNA, CRNA says in a news release. "One solution has been there all along, and is as simple as removing barriers to CRNAs’ ability to practice to the full extent of their education, training, certification, and licensure."

There are roughly 900 CRNAs in the system already, and granting them full practice authority would greatly increase the access to surgical and anesthesia care the VHA could provide for its veterans.

"Veterans are still waiting entirely too long to receive the quality healthcare they deserve and have earned in service to our country," Weiner says. "The AANA strongly urges the VA to solve this problem by using readily available healthcare resources – such as CRNAs – to the full extent of their practice authority."

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