After a tense period of debate over the new provider regulations by the Department of Veterans Affairs, on Dec. 14, those regulations were finally amended to allow full practice authority to APRNs employed at VA hospitals.
The pain point? CRNAs weren’t included in that ruling.
According to the final rule, certified nurse midwives, nurse practitioners, and clinical nurse specialists will be able to practice to the full extent of their training and education. But certified registered nurse anesthetists will not – and that exclusion has caused something of an uproar.
Why Are CRNAs Excluded?
The VA has stated in a news release that, because it does not have immediate, wide-ranging patient access challenges to anesthesia care throughout its health system, it has chosen not to include CRNAs as one of the roles that will receive full practice authority.
Obviously, this has left some in the nursing field with a bone to pick.
AANA President Cheryl Nimmo, DNP, MSHSA, CRNA, has expressed her disappointment with the VA’s decision because now “veterans will continue to deal with long wait times for needed healthcare procedures that require anesthesia services.”
And the solutions to that problem – highly qualified CRNAs – are being blocked from achieving their highest standard of practice because of this exclusion, which, in turn, affects veterans.
No Issues with Anesthesia Care?
While the VA claims there haven’t been widespread issues with anesthesia care, the VHA Independent Assessment tells another story. In 2015, they identified numerous problems in the anesthesia sector, such as:
- Cardiovascular surgery delays due to a lack of anesthesia support
- A rise in demand for procedures that require anesthesia outside of the OR
- Compared to the private sector, a sluggish production of colonoscopy services
Clearly, these things are issues – and they could be resolved if full practice authority had been granted to CRNAs.
Statements from AACN and ANA
The American Association of Colleges of Nursing (AACN) has acknowledged that the full practice authority granted to 3 APRN roles is progress. However, they are pushing for the policy to include CRNAS as well.
"AACN believes the full cadre of clinicians will not be maximized within the VHA if CRNAs are excluded," the organization stated via news release. "AACN appreciates the opportunity that the VA has provided to allow for an additional 30-day comment period on full practice authority for CRNAs. We stand firm in our view that CRNAs would increase access, and will submit additional comments to the VA in collaboration with our colleagues in the community."
These thoughts were reflected in an official statement by Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association.
"The American Nurses Association is pleased with the VA's final rule allowing APRNs to practice to the full extent of their education and training," she said. "However, ANA is concerned with the final rule's exclusion of CRNAs, which is solely based on the VA's belief that there is no evidence of a shortage of anesthesiologists impacting access to care. We join with our colleagues in continuing to advocate for CRNAs to have full practice authority within the VA health care system."
Fighting for Change in the Future
Many professional nursing organizations are planning to continue advocating for the inclusion of CRNAs in the ruling. Until the policy is changed, however, it’s likely that veterans will continue waiting too long for medically necessary procedures that involve anesthesia – and since caring for veterans is the focus of the VA, this seems like a significant oversight on the organization’s part.