VA runs the largest health-care system in the country, and the outcome of this potential change could reverberate in 29 states that still restrict the authority of nurses with advanced training.
The proposal to give nurses what’s called full practice authority, under consideration by VA for years, has pitted Washington’s big medical powerhouses against each other. On the nurses’ side, the 68,000-member American Association of Nurse Practitioners is leading a coalition trying to fend off physicians who oppose the change, with local radio and television spots, op-ed pieces and more than 10,000 comments on the Federal Register website. The American Society of Anesthesiologists and the American Medical Association are using similar strategies to convince VA to keep the status quo.
The veterans agency is facing a shortage of thousands of doctors and nurses as the demand for medical care grows. This has led to a challenge being closely watched by the public: How to whittle down long waiting lists for medical appointments that led to delays in treatment and cover ups that exploded into a nationwide scandal last year, forcing then- VA Secretary Eric Shinseki to resign.
VA’s solution is to give vast new authority to its most trained nurses to order and read diagnostic tests, prescribe medications and manage acute and chronic diseases — without a doctor’s oversight.
These nurses, who have advanced degrees, could practice independently even in the 29 states that still restrict what they can do, as long as they work for VA. The government would be following the lead of the military and 21 states and the District of Columbia that have expanded the scope of practice for nurse midwives, nurse practitioners and other nurses in a variety of medical fields.
But the plan has come under fire from some of the country’s largest doctors’ groups, who say VA would be lowering the standard of care for veterans, a population with a vast array of medical issues. Many physicians argue that the change is unwarranted and potentially dangerous to veterans.
The nurse practitioners group has fought back hard with media coverage and a letter-writing juggernaut urging members to pledge support to VA and Congress.
“We’ve had years of academic and clinical training,” Cindy Cooke, the group’s president, said in an interview. “There are services that are duplicative because you have physicians and nurse practitioners doing them.”
Cooke said she would “always” refer a patient who needed specialty care — in the fields of neurology or cardiology, for example — to a physician. “But there’s a great overlap of knowledge [that physicians and advanced-care nurses] already share,” she said.
VA officials have given conflicting messages about whether nurse anesthetists would increase their scope of care. They are included in the regulation, but VA says that is a mistake.
Nevertheless, the society of anesthesiologists has continued to be vocal in its opposition to a change, saying that its members, physicians, have more clinical training and experience than nurses and pointing out that VA does not have a shortage in this field.
The comment period ends July 25 at 11:59 p.m.
VA will make a final decision on the policy in the coming months, officials said.