Finally the VA is promoting nursing with their initiative to expand the role of Advanced Practice Registered Nurses to be fully independent. This will help reduce the extensive wait times that have restricted, and all too often precluded health care for our nation’s veterans.
Understandably, the public is fearful that allowing APRNs to fill the role usually reserved by physicians would reduce the quality of care administered to veterans, or worse, put veterans at risk by placing their health in the hands of those with significantly less training than physicians. We need to educate the public that APRNs can provide care sometimes even better than physicians because we have the nursing touch!
However, these fears are unfounded. APRNs have a Master’s level education or higher in specific fields of medical practice. Moreover, the VA’s revision would not allow APRNs to entirely substitute for physicians and take on all their respective physician duties. Rather, the revision allows APRNs to act without physician supervision in the specific field in which the APRN is trained and qualified. David J. Shulkin, undersecretary of health and leading doctor of the VA, attested to APRNs’ ability to deliver proper care in an interview with the Washington Post. Shulkin stated, “My assessment of the literature, which is vast on this subject in general, is that it has shown that nurses are able to deliver high-quality care, particularly when they are delivering care in settings that are within their competencies and scope of responsibilities. The literature shows very good outcomes”.
But what about when a situation arises in which an APRN is unsure or unprepared? Doesn’t this put the veteran’s health in jeopardy? The VA trusts APRNs to respect the limits of their training and ability. APRNs will know when to seek consultation from or to defer to a physician instead of acting on their own.
The current policy of prohibiting APRN’s from administering treatment to veterans in need without physician supervision severely restricts health care available to veterans, many of whom could receive proper treatment without a physician. These delays are the true cause of the deterioration of veterans’ health care.
Policies such as this also ignore the widespread success APRN’s have had with increased authority across the country. According to the American Association of Nurse Practitioners, 22 states allow nurse practitioners prescribe, diagnose, and treat patients without physician oversight, and 17 more allow only restrict the ability to prescribe.
It’s important to remember that additional training can always be provided. A possible improvement on the VA proposition would be to provide a hands-on program for physicians to give additional guidance to APRNs set to perform riskier procedures, such as anesthetists. The goal should be to share knowledge, making it more available for use, rather than reserving it for physicians alone.
With the nation’s shortage of physicians, especially in rural areas, fewer and fewer veterans have access to the health care they need. Allowing APRNs to take on a greater role and put to use their years of training would make great strides in delivering health care to veterans so urgently needed and deserved while reducing the delays for which many of them have no time to wait. If APRNs in the VA system are granted full practice authority, it would be a great step in furthering full practice authority in states which do not have it. What are your thoughts on the VA situation? Do you agree with me that APRNs should be granted full practice authority?