The U.S. Department of Veterans Affairs wants to improve our military veterans’ access to needed health care by fully utilizing certified registered nurse anesthetists, or CRNAs, and other advanced practice registered nurses, or APRNs, already practicing in the Veterans Affairs health system. The proposed rule, published in the May 25 Federal Register, would reduce long wait times for veterans to receive care — a dangerous situation that sadly has cost some vets their lives.
The issue has generated more than 70,000 letters to the VA so far, by far the highest number of comments for a proposed VA rule since the agency instituted online comment submission in 2006. Beyond a doubt, this is a topic of keen interest to veterans, their families and the American public.
This important new policy is supported by veterans groups such as AMVETS, Paralyzed Veterans of America, Military Officers Association of America and Air Force Sergeants Association; AARP, whose membership includes 3.7 million veteran households; numerous health care professional organizations, including the American Association of Nurse Anesthetists and other APRN associations; and 80 Democratic and Republican members of Congress.
Even more significantly, the proposed rule is supported by research evidence from no fewer than nine scientific studies on anesthesia safety published since 2000; results of an independent assessment of the Veterans Health Administration ordered by Congress in 2015; recommendations of the independent federal Commission on Care; a recommendation by the National Academies of Medicine that CRNAs be allowed to practice to the full extent of their education, training and abilities.
Supporting this proposed rule would continue to support team-based patient care, with all providers — surgeons, anesthesiologists, CRNAs and other health care professionals — working to their full capacity to provide the best quality of care possible to our veterans. It also would allow the VA to take full advantage of the VA’s existing anesthesia workforce, CRNAs and anesthesiologists alike. Research on anesthesia safety has confirmed time and again that patient outcomes are not improved when anesthesiologists supervise CRNAs. Therefore, the VA’s proposal is to make better use of its CRNAs by allowing them to practice to the full scope of their education, training and abilities without supervision.
It would also make better use of VA anesthesiologists by having them actually provide anesthesia or pain care instead of needlessly supervising other qualified providers. Imagine how much of a dent could be made in veterans’ wait times for care if all anesthesia professionals within the system were being fully utilized. This would help reduce the delays in obtaining health care for the veteran that has been spotlighted several times in the news in recent years. The independent assessment of the VHA identified delays in cardiovascular surgery for lack of anesthesia support, rapidly increasing demand for procedures requiring anesthesia outside the operating room and slow production of colonoscopy services in comparison with the private sector.
CRNAs undergo an extensive seven- to eight-year graduate-level education, which makes them fully qualified to care for even the sickest patients. They are the primary anesthesia provider assigned to the front lines during military actions to care for personnel horribly injured during battle and fully capable of caring for veterans stateside. To suggest otherwise is based on political posturing and not on evidence-based research.
The VA’s proposal stands to improve health care for veterans and to reduce wait times for the care they deserve and have earned. Public comments on the rule will be taken until July 25. It is critically important that veterans and those who care about them support the VA’s plan to allow full practice authority for CRNAs and other APRNs to the benefit of all veterans.
The public can make their voices heard at bit.ly/APRN-VA.
Bruce Rioux of Millinocket is a certified registered nurse anesthetist. He served in the U.S. Navy from 1974-1978.