NASS On Spine

August 02, 2016

VA Seeks to Mandate Independent Practice for all APRNS

Over 222,000 comments were submitted to the Veterans Affairs (VA) Department in response to a controversial proposal which expands advanced practice registered nurses (APRNs) scope of practice in the Veteran’s Health Administration (VHA). The closing of the comment period, which began in May, caps one of the most contentious and aggressive lobbying campaigns between medical providers and nurses in recent years.

The proposal, which aims to amend the VA’s medical regulations to permit full practice authority of all APRNs, would allow APRNs to practice to the full extent of their education, training and certification, without the clinical supervision of physicians. The proposed rulemaking would subdivide APRN’s into four separate categories that include certified registered nurse anesthetists.

Proponents of the VA’s proposal say that expanding APRNs practice authority would, among other things, lessen wait times for veterans seeking care and improving their access to care. It’s estimated that roughly a half million veterans experience wait times of 30 days or longer when seeking medical attention due to shortages in primary care and other medical services.

Opponents counter that the VA’s proposal would undermine the 28 states that require nurse practitioners to collaborate with or be supervised by physicians. There are few states which allow APRNs to practice independently, and that is only after an APRN has completed a certain number of clinical hours with physician’s supervision. Opponents also point to the insufficient evidence to support policy changes relating to extension of autonomous APRN practice and vast differences between APRN and physician medical training.

NASS has teamed up with several medical specialty societies, including the American Society of Anesthesiologists and the American Medical Association, in opposition to this proposed rule as it would directly compromise patient safety and limit spine specialists’ ability to provide quality care to veterans. NASS expects a final decision on the rule to come out later this year and will continue to monitor in the lead up to its release.


Back to Articles