The Veterans Administration is proposing to allow advanced practice registered nurses to practice to the full scope of their education, licensure and certification.
APRNs are defined as certified registered nurse anesthetists, nurse practitioners, certified nurse midwives and clinical nurse specialists. The Veterans Health Administration proposal does not remove physicians from patient care; rather, it emphasizes better utilization of the existing 6,000-plus nurse anesthetists and other APRNs currently serving in VA health care facilities to provide needed health care services in a timelier way.
The proposal is based on strong evidence. Supervision of nurse anesthetists by anesthesiologists is not required in any state, and nurse anesthetists practice autonomously in all branches of the military.
Since 2001, 17 states, including California, have opted out of nurse anesthetists’ supervision requirements as a condition for reimbursement from the Centers for Medicare and Medicaid Services. There simply is no evidence to support the claim by anesthesiologists that anesthesia services delivered by nurse anesthetists are of lesser quality.
This fact is confirmed by results of an independent assessment of the Veterans Health Administration ordered by Congress and published in 2015, which concluded physician organizations lack evidence to support their claim that nurse anesthetists placed patients at risk when working without physician supervision.
In fact, the evidence confirming that nurse anesthetists ensure access to safe anesthesia care for millions of Americans – including veterans – is overwhelming. A study published just this month in the peer-reviewed scientific journal Medical Care found no measurable impact from expanded nurse anesthetists’ scope of practice on anesthesia-related complications in more than 5.7 million anesthetics.
No fewer than eight other research studies published since 2000 confirm nurse anesthetists’ safety and effectiveness. Bombastic statements such as “CRNAs will hurt vets” or “Don’t dishonor our veterans by denying their choice of a physician” amount to fear-mongering and theatrics and are a disservice to our veterans and the public.
Layers of supervision provide no evidence-based benefits, drive health care costs higher and needlessly increase veterans’ wait times for services. This is hardly the way to honor the service of veterans or provide the quality of care they deserve.
Nurse anesthetists comprise the vast majority of anesthesia providers assigned to the front lines during military actions to care for our nation’s soldiers. Frequently, soldiers who require their services are horribly and traumatically injured during battle.
Caring for our men and women on the battle lines in wartime service is certainly no less complicated than caring for these same individuals when they become veterans and return stateside.
To be clear, both nurse anesthetists and anesthesiologists are needed to work to their full capacity in order to provide the care veterans need. This is the ultimate purpose of the VHA proposed rule; it does not replace one provider with another.
The VHA independent assessment ordered by Congress identified delays in cardiovascular surgery for lack of anesthesia support, rapidly increasing demand for procedures requiring anesthesia outside of the operating room and slow production of colonoscopy services in comparison with the private sector. The assessment concluded that allowing nurse anesthetists to practice to their full scope would greatly enhance the quality and efficiency of the VHA.
Juan Quintana, president of the American Association of Nurse Anesthetists wisely stated in a recent news conference that “It’s time for evidence to trump politics when it comes to the health of our veterans.”
Under the VHA proposed rule, both nurse anesthetists and anesthesiologists in the VHA will continue to work with physicians, surgeons and other health care professionals to provide the highest-quality care for our honored veterans.
More than 60 organizations support this policy change, including veterans’ groups such as the Military Officers Association of America and the Air Force Sergeants Association; AARP, whose membership includes 3.7 million veteran households; health care professional organizations including nurse anesthetists organizations and the American Nurses Association; and 80 Democratic and Republican members of Congress. California veterans and those who care about them are encouraged to express support for the VA proposal at www.veteransaccesstocare.com.
Bryan Tune of Clovis is a nurse anesthetist at Omni Anesthesia Associates in Fresno.