(Story updated at 3:36 p.m. ET)
The Veteran Affairs Department wants to allow advanced practice registered nurses to practice to their full authority at VA facilities.
The change has long been debated at the VA and in Congress but is opposed by the American Medical Association and the American Society of Anesthesiologists.
The VA argues in the proposed rule posted Wednesday that it will expand veterans' access to healthcare by increasing the number of available primary-care providers.
The VA wait times scandal in 2014 pushed the agency toward trying to hire more providers, but officials have said bureaucratic barriers have slowed the process.
“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,” according to the rule.
Opposition to the rule has focused on certified registered nurse anesthetists. The ASA maintains that a physician anesthesiologist should always be present in the operating room in case of a medical emergency. The group says there is no shortage of physician anesthesiologists and the rule would mean “lowering the standard of care for our veterans and putting their lives at risk.”
About half of states have full scope of practice laws for nurse practitioners.
The American Nurses Association and the American Association of Nurse Practitioners support the rule, according to statements released Wednesday.
"Veterans stand to significantly benefit from this essential VA policy update, which gives them unencumbered access to nurse practitioners and the excellent, compassionate and patient-centered care they provide," AANP President Cindy Cooke said.
Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. By comparison, nurse anesthetists have about half the education and almost 2,500 hours of clinical training according to the ASA.
The AMA said in a statement that the proposal moves away from team-based care led by physicians and would undermine the delivery of care at VA.
“The AMA urges the VA to maintain the physician-led model within the VA health system to ensure greater integration and coordination of care for veterans and improve health outcomes,” according to the statement.
David Shulkin, undersecretary for health at the VA, said implementation of the final rule through Veterans Health Administration policy would clarify which of the four APRN roles would be granted full authority. Those roles are certified nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist and certified nurse midwife.
“This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing,” Shulkin said.
The American Association of Nurse Anesthetists also applauded the VA for the proposed rule.
“Improving the VHA's ability to provide better, faster care to our veterans doesn't necessarily require increasing budgets or staff,” AANA President Juan Quintana said. “One solution has been there all along, and is as simple as removing bureaucratic barriers to APRNs' ability to be credentialed and practice to the full extent of their education, training, and certification.”
Comments on the rule will be accepted until July 25.
