VA Grants Advanced Practice Nurses Direct Access to Patients Within Scope of VA Employment

The Veterans Administration (VA), the largest integrated health system in the US, passed a new rule last week to allow Advanced Practice Registered Nurses (APRNs) full practice authority without physician supervision within its network. Nurses along with veterans, their families, and caregivers have been lobbying for the VA to grant full practice authority to APRNs for quite some time. The VA finally responded in May with a proposal to allow APRNs to work to the full extent of their education, training, and certification without physician supervision, a proposal which has finally been granted.

Three types of APRNs have been approved to practice under the new ruling: certified nurse practitioners, clinical nurse specialists, and certified nurse midwives. They will be allowed to practice to the full extent of their training and education regardless of state laws including providing physical exams, health assessments, and screenings; diagnosing, treating, and managing acute and chronic diseases; ordering laboratory tests and integrating results into clinical decision-making; prescribing medications and medical equipment; and making referrals. Certified registered nurse anesthetists (CRNAs) have been excluded from the rule for the time being, but the VA has been urged by critics to reconsider their exclusion.

Dr. Cindy Cooke, DNP, FNP-C, FAANP, President of the American Association of Nurse Practitioners (AANP), released a statement in response saying, “This final rule is a critical step for America’s veterans to be able to obtain timely, high quality care in the Veterans Health System…America’s nurse practitioners are honored to continue to serve our nation’s veterans by providing them with direct access to the high-quality health care they deserve.”

The VA has been receiving backlash from physician organizations since their proposal was first announced, arguing that veterans deserve physician-led patient care. However, their arguments have been overruled by more effective arguments from the American Nurses Association (ANA) that nurse practitioners are “a zero cost, zero risk solution” to strengthening care for the veterans who have served our nation by providing them with access to timely and efficient care.