VA Rules on Advanced Practice Nurses


Responding to problems with long delays in getting care at Veterans Affairs facilities, the agency announced today it would expand the duties of some advanced practice nurses, but not of nurse-anesthetists. The American Medical Association was quick to respond.

military medicine, advanced practice nurse, veterans administration, American Medical Association, family medicine, internal medicine

A turf war between physician organizations and nursing groups over the scope of practice of nurses at the Department of Veterans Affairs (VA) facilities ended in a partial victory for both sides today.

At issue was whether the VA could save money and extend services to veterans by making greater use of advanced practice nurses.

In a final rule announced today, the VA said it would permit full practice authority of three roles of VA advanced practice registered nurses--meaning they could work without direct physician supervision-- but that the change would not extend to certified registered nurse anesthetists.

Responding to the announcement, the American Medical Association’s President Andrew Gurman, MD, said it agrees with the decision to exclude the nurse anesthetists but “. . .we are disappointed 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.”

The AMA says allowing the advanced practice nurses to take on more care “will rewind the clock to an outdated model of care delivery that is not consistent with the current direction of the healthcare system.”

The group also applauded a VA decision clarifying that radiology studies should not be read by nurses who have not been credentialed in that skill.

“All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine, in addition to the valuable care provided by advanced practice nurses and other primary care clinicians that are part of the care team,” Gurman concluded.

The VA’s document “Advanced Practice Registered Nurses, Final Rule with Comment Period” will be published in tomorrow in the Federal Register. There will be comment period following publication.

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