On The Quick
Update on the VA and Full Practice Authority for APRNs
Controversial proposal received 222,644 comments
In May, the Veterans Administration proposed new regulations that would give full practice authority to all Veterans Healthcare Administration (VHA) advanced practice nurses. When the public comment period ended on July 25, the controversial proposal had received an astounding 222,644 comments.
“A Dangerous Proposal”
The VA proposal seeks to expand primary care capacity, especially in medically underserved rural areas, by allowing all of the VHA’s more than 6,000 advanced practice registered nurses to practice almost completely autonomously within the scope of their VHA employment. These goals mirror those of recent legislative efforts to remove physician supervision requirements for APRNs at the state level.
The arguments against the proposal are similarly familiar. Physicians’ organizations, which widely oppose APRN autonomy, paint the proposal as a diminution of the VHA’s current, physician-centric standards of care. In an official statement released in May, AMA Board Chair Stephen R. Permut, M.D., J.D., declared that “this proposal will significantly undermine the delivery of care within the VA.”
The prospect of granting autonomy to the VHA’s certified registered nurse anesthetists drew a ferocious response from the American Society of Anesthesiologists (ASA). That organization’s online campaign (at www.asahq.org) solicited a substantial number of the public comments opposing what ASA President Daniel J. Cole, M.D., calls a “dangerous proposal that runs counter to the VA’s own strategy to deliver high-quality, veteran-centered care.”
Federal Rule or State-by-State?
Some physicians and conservative commentators are also alarmed that the VA proposes to preempt state licensing laws. The legal foundation is a Clinton-era executive order that gives federal agencies limited override authority “when the exercise of state authority directly conflicts with the exercise of federal authority.”
The VA argues that APRN autonomy is essential to meeting the agency’s statutory obligations to veterans’ healthcare and that preemption is the only practical solution. The alternative would be a state-by-state lobbying effort that the agency says, “would be costly and time consuming for VA and would not guarantee the desired result of full practice authority to all [VHA] APRNs.”
The Veterans Administration must now review all the comments and formulate its official response before issuing a final rule. Considering the volume of comments received, it may be some time before the VA decides how to proceed. ANA President Pamela F. Cipriano, RN, Ph.D., NEA-BC, FAAN, whose organization strongly supports the VA proposal and worked to solicit positive public comments, says, “This level of interest in the proposed rule shows that people are concerned about the quality of veterans’ healthcare and want solutions that will ensure access to care and keep our veterans healthy."
This article is from workingnurse.com.