VA Proposes Advanced Practice Nurses Work Independently

The U.S. Department of Veterans Affairs (VA, Washington, DC, USA) wishes to amend its medical regulations to permit full practice authority for all advanced practice registered nurses (APRNs) without the clinical supervision of physicians.

According to the VA, the amendment would increase veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification. It would also permit the VA to use its health care resources more effectively in a manner more consistent with the role of APRNs in the non-VA health care sector, while maintaining patient-centered, safe, high-quality health care for veterans.


The proposed rulemaking would subdivide APRN's into four separate categories, including certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, and certified nurse-midwife. The proposed rulemaking would also define the scope of full practice authority for each category of APRN, and provide the criteria under which the VA may grant full practice authority to an APRN in one of the four APRN roles, consistent with the nursing profession's standards of practice for such roles.

“The VA is proposing this policy to ensure a consistent continuum of health care across the Veterans Health Administration by decreasing the variability in APRN practice that currently exists as a result of disparate State practice regulations,” the VA stated in a press release. “This would increase veteran access to needed VA health care, particularly in medically-underserved areas, as well as decrease the amount of time veterans spend waiting for patient appointments.”

“We feel this proposal will significantly undermine the delivery of care within the VA,” said Stephen Permut, MD, JD, chair of the American Medical Association (AMA; Chicago, IL, USA) board of trustees. “All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine ... The AMA urges the VA to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes.”

“Removing physician anesthesiologists from surgery and replacing them with nurses lowers the standard of care and jeopardizes Veterans' lives,” commented Daniel Cole, MD, president of the American Society of Anesthesiologists (ASA; Schaumburg, IL, USA). “This policy change is based on a shortage of some types of physicians in the VA; however, there is no shortage of physician anesthesiologists in the VA.”

Related Links:
U.S. Department of Veterans Affairs
American Medical Association
American Society of Anesthesiologists