The Veteran Affairs Department has finalized a rule that will allow advanced-practice registered nurses to practice to their full authority at VA facilities, however the new permission will not expand to certified registered nurse anesthetists following lobbying from anesthesiologists.
The change has long been debated at the VA and in Congress but is opposed by the American Medical Association, which immediately slammed the rule after its release Tuesday.
“This part of the VA's final rule will rewind the clock to an outdated model of care delivery that is not consistent with the current direction of the healthcare system,” Dr. Andrew Gurman, president of the AMA said in a statement, adding that state law should be followed.
About half of states have full scope of practice laws for nurse practitioners.
The VA believes the rule will make it easier for veterans to be seen by medical professionals by increasing the number of available primary-care providers. The new policy is effective Jan. 14, 2017.
After the VA was slammed for inordinate wait times at some of its facilities, the agency hired more providers, but officials have said bureaucratic barriers have slowed the process.
The American Society of Anesthesiologists had opposed the VA's proposal to expand the scope of practice for certified registered nurse anesthetists. The ASA felt 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.”
Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. Nurse anesthetists have about half the education and almost 2,500 hours of clinical training, according to the ASA.
The VA appears to have been swayed by comments .
“VHA believes that VA does not have immediate and broad access problems in the area of anesthesia care across the full VA health care system that require full practice authority for all CRNAs,” the rule said. The VA will take comments on that decision until Jan. 14, 2017.
In an earlier comment period following the draft rule, the VA received 223,296 comments. Of those, 104,256 comments were against granting full practice authority to VA CRNAs. Another 45,915 comments supported full practice authority without specific mention of CRNAs, and 9,613 comments supported full practice authority for CRNAs.
Groups such as the American Association of Nurse Practitioners said the move can only help America's veterans.