What Can I Do?
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About the Issue
Veterans who have served our country deserve quality, safe and effective health care. Limiting APRNs practice in the Veterans Health Administration puts our veterans at risk due to backlogs and waitlists for receiving treatment.
Help us urge the VA to include CRNAs in the final rule
Have you heard the good news? Advanced practice registered nurses (APRNs) -- including Nurse Practitioners, Certified Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs) and Certified Nurse-Midwives (CNMs) -- will now have full practice authority within the VA health system! This is a win for veterans -- as well as the VA nurses who treat them -- and a regulation for which ANA has been advocating strongly for a number of years.
Tremendous thanks is due to the nursing community for helping break records in expressing support for this proposed rule. The VA received an extraordinary number of comments -- more than 177,000 in the docket as of this writing -- during the public comment period, which ended July 25. Prominent groups, including the Federal Trade Commission, AARP, the American Hospital Association, and the Robert Wood Johnson Foundation, all joined ANA in expressing support for the rule.
Working with our partner organizations as part of the Veterans Access to Quality Healthcare Alliance, ANA rallied nurses and other stakeholders to participate in a social media campaign, which reached more than 300,000 people and drove a significant amount of traffic to the VA comment site. Additionally, ANA co-hosted a press conference, published a Huffington Post blog, and submitted letters to the editor that were published in The Washington Post and USA Today in support of veterans’ access to timely, quality health care.Why this Rule is Important
First and foremost, veterans who have served our country deserve quality, safe and effective health care. This rule expands veterans' access to care by offering them a full range of qualified health professionals, such as APRNs. We expect that this rule will help address the backlogs and waitlists for veterans to receive treatment that you likely have read about in the news. This rule is consistent with the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health, which recommends that APRNs working in the VA practice to the full extent of their education and training.
The rule is a victory for nurses because it affords three of the four APRN roles full practice authority when they are acting within the scope of their VA employment. This means that APRNs employed by the VA will be able to provide certain services "without the clinical oversight of a physician, regardless of state or local law restrictions."
This matters because each state governs APRN practice at varying degrees. For example, the same nurse practitioner is required to have more physician oversight in Kansas City, MO, than across the state line in Kansas City, KS. But APRNs' ability to provide safe, cost-effective, high-quality care has been well documented in many studies over the past 30 years.
The VA is the nation's largest employer of nurses and is often on the cutting edge of health policy. Other employers of nurses look to the VA for best practices and often follow suit.What's Next
Unfortunately, the rule excludes Certified Registered Nurse Anesthetists (CRNAs), which is solely based on the VA’s belief that there is no evidence of a shortage of anesthesiologists impacting access to care. ANA is committed to advancing full practice authority for all four APRN roles, and will continue our advocacy on behalf of CRNAs within the VA health care system. The final rule will be effective on January 13, 2017. Thankfully, there is still time to fight for CRNA inclusion during the public comment period as part of its full implementation. Together, we can urge the VA to implement this groundbreaking rule and include CRNAs to improve access to care for our Veterans.
- Letter from the National Council of State Boards of Nursing to Secretary McDonald (7/2016)
- In The Washington Post: Proposed VA rule is about providing better care to veterans (7/2016)
- Fact Sheet — Veterans Access to Quality Care Act
- Veterans Access to Quality Healthcare Alliance
- ANA Press Release
- Letter to Senator Merkley from the Nursing Community (10/2015)
- Letter to Reps. Graves and Schakowsky from the Nursing Community (3/2015)
- WSJ Article: At VHA, Doctors, Nurses Clash on Oversight (1/2014)
- Letter of Support from the Nursing Caucus for VHA Handbook (11/2013)