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VA Grants APRNs Full Practice Authority. Almost.

Analysis  |  By Jennifer Thew RN  
   January 03, 2017

The VA declines to give certified nurse anesthetists full-practice authority, claiming there is no issue with access to anesthesia care. Nursing organizations disagree.

After a comment period that spurred much debate and garnered 179,734 public comments, on Dec. 14 The Department of Veterans Affairs announced it is amending its provider regulations to all allow full practice authority to APRNs employed at the VA.

But not all of them.

The final rule will allow the VA's certified nurse midwives, clinical nurse specialists, and nurse practitioners to practice to the full extent of their education, training, and certification. The agency declined, however, to grant full practice authority to certified registered nurse anesthetists.

In a news release, the VA said it did not have immediate and broad patient access challenges to anesthesia care across its health system and therefore chose not to finalize the provision which included CRNAs as one of the APRN roles receiving full practice authority.

Some in nursing are disappointed with this decision.

"The AANA is terribly disappointed by the VA's decision to not grant full practice authority to CRNAs because now veterans will continue to deal with long wait times for needed healthcare procedures that require anesthesia services," AANA President Cheryl Nimmo, DNP, MSHSA, CRNA told HealthLeaders Media via email.

"And the solution to the problem is right there—a highly educated, qualified, motivated, and proven CRNA workforce that is currently being underutilized due to practice barriers imposed by physicians to benefit physicians. Let me be clear: Veterans are not the beneficiaries of this decision."

Nimmo points out that while the VA says there is no issues with access to anesthesia care, the VHA Independent Assessment in 2015 identified numerous access problems such as:

  • Delays in cardiovascular surgery due to lack of anesthesia support
  • Increasing demand for procedures requiring anesthesia outside of the operating room
  • Slow production of colonoscopy services in comparison with the private sector

"This clearly speaks to the underutilization of CRNAs, and it also raises questions about anesthesiologists who spend their time supervising CRNAs rather than actually providing hands-on patient care," she wrote.

"Just imagine how many more veterans could be cared for if start times for surgical and other types of cases requiring anesthesia were no longer delayed unnecessarily while waiting for supervising anesthesiologists to become available."

While The American Association of Colleges of Nursing acknowledges the VA allowing three APRN roles full practice authority is progress, it agrees the policy needs to be extended to include CRNAs.

"AACN believes the full cadre of clinicians will not be maximized within the VHA if CRNAs are excluded," the organization said in a news release.

"AACN appreciates the opportunity that the VA has provided to allow for an additional 30-day comment period on full practice authority for CRNAs. We stand firm in our view that CRNAs would increase access, and will submit additional comments to the VA in collaboration with our colleagues in the community."

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association echoed those sentiments.

"The American Nurses Association is pleased with the VA's final rule allowing APRNs to practice to the full extent of their education and training," she said in an official statement.

"However, ANA is concerned with the final rule's exclusion of CRNAs, which is solely based on the VA's belief that there is no evidence of a shortage of anesthesiologists impacting access to care. We join with our colleagues in continuing to advocate for CRNAs to have full practice authority within the VA health care system."

The AANA plans to continue to advocate for full practice authority to be extended to CRNAs at the VA.

"We are charging full steam ahead. A grave injustice has been done to our nation's veterans, who deserve much better. I'm a veteran, so I can sympathize," says Nimmo. "CRNAs are ready to help change the VA culture that long wait times for care are OK. They are not OK. We plan to keep delivering that message until the VA finally gets this right."

Comments on the final rule and full practice authority for CRNAs can be submitted to the VA until January 13, 2017.

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

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