A controversial new proposal from the Department of Veteran’s Affairs (VA) would give advanced nurses authority to perform some of the functions that VA doctors perform. The VA claims that this is a way to cut down on the wait times veterans face for appointments because of the shortage of medical professionals. However, doctors worry that the quality of care will be sacrificed and the health of veterans put at risk.
The new regulations would grant significant new authority to most advanced VA nurses to order and read diagnostic tests, administer anesthesia, prescribe medications, and manage acute and chronic diseases. This would all occur without the supervision of a doctor.
If passed, the VA would join the military and almost half of states that have expanded the roles and practices of nurses, nurse practitioners, nurse anesthetists, and nurse midwives across the country.
According to the Office of the Federal Register’s summary of the proposed rule:
… would increase veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians. This rule would permit VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA. The proposed rulemaking would establish additional professional qualifications an individual must possess to be appointed as an APRN within VA. The proposed rulemaking would subdivide APRN's into four separate categories that include certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, and certified nurse-midwife… VA intends that the services to be provided by an APRN in one of the four APRN roles would be consistent with the nursing profession's standards of practice for such roles.
In short, VA nurses would have a lot more authority to do what their bosses – VA doctors- already do. We might expect that not only would more veterans be seen sooner by medical professionals, but doctors could focus on the more serious cases.
Nursing is already a fast-growing field and would only attract more American workers. They are certified medical professionals with increasingly more responsibility, but without a medical degree and the debt involved in pursuing it.
Doctors adamantly oppose this plan citing the damage that can be done if they do not administer medical care. The Washington Post reports:
“The nation’s top health care systems rely on physician-led teams to achieve improved care and patient health, while reducing costs,” Dr. Stephen R. Permut, president of the American Medical Association, the nation’s most prominent physician organization, said in a statement.
“We expect the same for our country’s veterans,” Permut said. ” All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine.”
The American Society of Anesthesiologists, which represents 53,000 physicians, also opposed the proposed policy, saying that “removing anesthesiologists from surgery and replacing them with nurses” would be “lowering the standard of care and jeopardizing Veterans’ lives.”
The group said nurse anesthetists have half the education and a fraction of the training of physicians.
The American Nurses Association is supportive of the measure and thinks that long-standing limits on the scope of care that nurses with advanced training can provide has led to staff shortages and ensuing backlogs at the VA. Meanwhile, doctors and anesthesiologists claim that only they can provide quality care to veterans. Both have financial interests and power plays in mind.
It’s a battle of the he-said, she-said over what could be an interesting partial solution to the shortage of medical staffing at VA hospitals. Our veterans are caught in the middle of a hospital fight over their care and, sadly, their care continues to take a back seat.