Following up on a proposal filed earlier in 2016, the U.S. Department of Veterans Affairs (VA) has decided "to permit full practice authority of three roles of VA advanced practice registered nurses (APRN)" within the scope of VA employment, as the agency announced in a statement filed this week.
The new VA nurse practitioner ruling grants NPs the power to "work independently without physician supervision everywhere in its network, the largest integrated health system in the United States," writes Alicia Ault for Medscape.
The VA nurse practitioner proposal, from May 2016, was designed in part to improve veteran access to care after a period in which the department has been "accused of mismanagement and not promptly treating veterans who are known to wait days, weeks and even months for treatments and basic primary care services," writes Bruce Japsen for Forbes.
Certified registered nurse anesthetists (CRNAs), who had also been part of the proposal for expanded VA practice, were specifically excluded from the new ruling, which allows "three types of APRNs — certified nurse practitioner, clinical nurse specialist, and certified nurse-midwife — to practice to the full extent of their training and education, regardless of state laws," Ault writes.
"Among the duties envisioned: providing physical examinations and other health assessment and screening activities; diagnosing, treating, and managing patients with acute and chronic illnesses and diseases; ordering laboratory and imaging studies and integrating results into clinical decision-making; prescribing medication and durable medical equipment; and making referrals.
"Under the final rule, APRNs may not perform, supervise, or interpret medical imaging exams, which the American College of Radiology (ACR) said it had backed," Ault adds.
Dated December 13, the new rules are slated to go in effect on January 13, following a 30-day period allowing for public comment.
VA Nurse Practitioner Ruling: NP Groups "Pleased," Physician Groups "Disappointed"
The ruling is, of course, being celebrated by nurse practitioner organizations, expanding as it does the capacity of America's NPs to find greater career engagement within the VA, and enjoy legitimization as autonomous healthcare providers within the healthcare industry nation in general.
"We are pleased the VA will move forward with allowing veterans throughout the country to have direct access to nurse practitioner provided health care," Dr. Cindy Cooke, DNP, FNP-C, FAANP, President of the American Association of Nurse Practitioners (AANP), stated in a news release. "With 4,800 nurse practitioners currently working in VA facilities nationwide, this is a zero cost, zero risk solution and a significantly positive step to strengthening care for those who served our nation."
"America's nurse practitioners are honored to continue to serve our nation's veterans by providing them with direct access to the high-quality health care they deserve," Dr. Cindy Cooke added. "We trust that in the near future, the VA will propose a plan to include Certified Registered Nurse Anesthetists (CRNAs) in this provision."
Not everyone is as pleased with the VA nurse practitioner ruling. As Ault notes, it "drew a frustrated response from physician organizations."
Andrew W. Gurman, MD, President of the American Medical Association (AMA), the nation's largest association of physicians and medical students, issued a statement in which the organization expressed disappointment "by the VA’s decision today to allow most advanced practice nurses within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law.
Though that same statement expressed approval that the VA "continues to recognize the critical need for collaboration among physicians and nurse anesthetists to ensure patient safety when delivering anesthesia care," it added that the VA nurse practitioner ruling "will rewind the clock to an outdated model of care delivery that is not consistent with the current direction of the healthcare system."
The ruling follows up a proposal from May 2016 by the VA "allowing APRNs to work to the full extent of their education, training, and certification, without physician supervision," as Ault puts it. "The proposal won the support of many nursing organizations and several veterans' groups, including the Military Officers Association of America, and the Air Force Sergeants Association."
Similarly, the VA attributed its decision not to include CRNAs in the expanded scope of practice in part to the efforts of the American Society of Anesthesiologists (ASA), which lobbied against the proposal. "The agency said it received 104,256 comments against granting CRNAs full-practice authority," Ault notes.
All the same, the VA nurse practitioner ruling is "a victory for the nation’s nurse practitioners," and comes "at a critical time for nurse practitioners, which have doubled to more than 200,000 in the last decade and are looking to expand their ability to care for patients across the country," Japsen writes.
"Nurse practitioners are becoming more familiar to patients in all settings, proliferating across the country in doctor's offices, hospitals and retail clinics run by CVS Health, Walgreens and Walmart stores," Japsen adds. "The popularity of nurse practitioners and the care they provide helped bring an onslaught of support from the public to the VA during the public comment period regarding the rule."
What does this mean for the nation's locum tenens nurse practitioners? There's no indication yet whether the VA will match the new rules with increased NP hiring, but it stands to reason as a possibility. If you're a nurse practitioner interested in exploring a locum tenens job opportunity in a VA facility — or in any other practice setting — we encourage you to contact Staff Care today! An experienced, highly knowledgeable locums NP recruiter will be happy to discuss your career prospects and match you with the opportunity that best meets your personal preferences and professional goals.
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